Drs. Kalunian and McMahon explain how inflammation in areas of interstitial fibrosis and tubular atrophy (i-IFTA) in lupus nephritis is not inert scarring, but rather an active, prognostically powerful process that strongly predicts the decline of estimated glomerular filtration rate. They argue that recognizing and routinely scoring i-IFTA could transform clinical practice by shifting focus beyond glomerular lesions to the tubulointerstitial compartment, opening new avenues for risk stratification and potentially for targeted therapy.
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