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Management of lupus nephritis: ACR 2024 guidelines
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The ACR issued evidence-based expert guidance for the screening, treatment, and management of LN in adults and children with SLE. The guidelines comprise 28 graded recommendations (7 strong and 21 conditional) and 13 ungraded consensus-based GPSs.1 We summarize the key recommendations and GPSs, highlighting the importance of prompt kidney biopsy and appropriate LN treatment. |
| Key learnings |
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Strong recommendations:
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| Kidney biopsy should be performed promptly in patients with SLE when LN is suspected (GPS), and in patients with SLE who have proteinuria >0.5 g/g and/or impaired kidney function not otherwise explained (conditional recommendation). |
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Conditional recommendation for patients with active/ND/flare of Class III/IV ± V to be treated with triple immunosuppressive therapy:
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| Conditional recommendation for patients with refractory LN of any class to undergo treatment escalation with a more intensive regimen, including anti-CD20 agents, or combination therapy with three non-GC immunosuppressives (MPAA, belimumab, and CNI), or referral to investigational therapy. |
| Shared decision-making is important for preserving kidney function, overall health, and QoL. |
Abbreviations: ACR, American College of Rheumatology; CNI, calcineurin inhibitor; CRR, complete renal response; CYC, cyclophosphamide; ELNT, EuroLupus Nephritis Trial; GC, glucocorticoid; GPS, good practice statement; IV, intravenous; LN, lupus nephritis; MP, methylprednisolone; MPAA, mycophenolic acid analogs; ND, newly diagnosed; QD, once daily; QoL, quality of life; SLE, systemic lupus erythematosus.
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