Abstract
Purpose: Chronic inflammation plays a key role in diabetic nephropathy (DN), yet the impact of tertiary lymphoid structures (TLSs) on disease progression remains poorly understood. This study explored the relationship between TLS maturity and renal outcomes in patients with DN. Methods: This study included 117 biopsy-confirmed DN patients from the First Affiliated Hospital of Fujian Medical University. Patients were grouped based on TLS maturity, as determined by immunohistochemical staining. Clinical, laboratory, and pathological data were gathered, and Cox regression models were applied to assess renal outcome risk factors. Kaplan-Meier curves were constructed to compare renal survival among groups. A web-based model integrating TLS maturity, urinary albumin-to-creatinine ratio (UACR), and renal pathology classification was developed. Results: Mature TLSs were associated with worse renal prognosis, with greater disease progression in the TLS+ group (75.4% vs. 53.3%, p = 0.006). Multivariate Cox regression analysis identified TLS maturity (HR = 1.819, 95% CI: 1.144-2.893, p = 0.011), DN glomerular classification (HR = 1.511, 95% CI: 1.057-2.160, p = 0.024), and UACR (HR = 1.121, 95% CI: 1.038-1.210, p = 0.004) as independent risk factors. The dynamic nomogram demonstrated strong predictive performance. Conclusions: TLS maturity independently predicts renal function decline in DN and may support personalized risk assessment through a web-based model.