## 4 Research and Project Aimed at Developing Modules of a Classification and Expert System
### Final Classification After Treatment Module
#### 4.3.1 Input-Output MIMO Framework  
The seven distinct outcome classes are defined by clinical markers such as proteinuria, serum albumin, and serum creatinine levels, as well as the patient's response to treatment. These categories are described in Table 5. Expert knowledge from the literature [66] was used to literally describe the thresholds for class membership of feature ranges and then manually divide them for training and testing. The classification model operates using a MIMO structure. The inputs include clinical data collected at six months post-treatment, such as proteinuria levels, serum albumin concentration, and serum creatinine levels. The output is the assigned outcome category, which reflects the patient's response to treatment. \begin{table}
\begin{tabular}{l l} \hline \hline
**Category** & **Description** \\ \hline Class 1—complete remission of FSGS & Reduction in daily proteinuria to \textless{}0.3 g/d or \\  & PCR \(<\) 300 mg/g (\textgreater{}30 mg/mmol), normal serum \\  & creatinine, and serum albumin \textgreater{}3.5 g/dL (\textgreater{}35 g/L). \\ \hline Class 2—partial remission of FSGS & Reduction in daily proteinuria to 0.3-3.5 g or PCR \\  & 300–3500 mg/g (30-350 mg/mmol), or a 50\% reduction \\  & from baseline. \\ \hline Class 3—relapse of FSGS & Increase in daily proteinuria to \textgreater{}3.5 g or \\  & PCR \(>\) 3500 mg/g (\textgreater{}350 mg/mmol) after achieving \\  & complete remission, or a \textgreater{}50\% increase in proteinuria \\  & during partial remission. \\ \hline Class 4—steroid-resistant FSGS & Persistent daily proteinuria \textgreater{}3.5 g or PCR \textgreater{}3500 mg/g (\textgreater{}350 mg/mmol), or \textless{}50\% reduction from baseline \\  & despite treatment with prednisone 1 mg/kg/d or 2 mg/kg \\  & every other day for a minimum of 16 weeks. \\ \hline Class 5—steroid-dependent FSGS & Relapse occurring within 2 weeks of stopping steroid \\  & treatment. \\ \hline  & Persistent daily proteinuria \textgreater{}3.5 g or \\  & PCR \(>\) 3500 mg/g (\textgreater{}350 mg/mmol), or \textless{}50\% \\  & reduction from baseline despite treatment with \\  & cyclosporine (target trough 100–175 ng/mL) or \\  & tacrolimus (target trough 5–10 ng/mL) for 4–6 months. \\ \hline Class 7—calcineurin & Relapse occurring within 2 weeks of stopping \\  & inhibitor-dependent FSGS & calcineurin inhibitor therapy. \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Outcome categories for final assessment after six months of treatment. Figure 6 illustrates the classification model's architecture, including the inputs and outcome categories. The classification operates within a structure, where 13 clinical features serve as input variables, and the system generates one of seven output categories. The features encompass critical markers of renal function, disease activity, and therapeutic response. The system relies on predefined clinical thresholds to ensure consistency with nephrology guidelines. The MIMO structure ensures flexibility and robustness in the classification process. The 13 inputs were evaluated using predefined thresholds from Table 5, which enabled the manual classification of training and test data for model building. The outputs were mapped to the appropriate output class. The MIMO structure enables the system to handle complex relationships between inputs while providing clear, actionable classifications for clinicians. The classification system supports clinicians in evaluating treatment efficacy and determining the next steps in patient management. By automating the classification process, the system reduces variability and improves decision-making consistency. The integration of interactive elements allows clinicians to view detailed explanations of each category and adjust management plans accordingly. Clinicians input patient data, and the system automatically categorizes the patient into one of the seven classes.