Quality indicators for lupus nephritis based on 2025 EULAR recommendations

Results from a study conducted to develop and validate quality indicators (QIs) for lupus nephritis (LN), based on the 2025 European Alliance of Associations for Rheumatology (EULAR) recommendations, were published in the Annals of the Rheumatic Diseases by Akat et al. The primary objectives were to support the implementation of QIs, facilitate the translation of state-of-the-art into real-life clinical practice, identify areas for improvement, and provide healthcare professionals with a standardized assessment tool. Adherence was assessed in a single-center LN cohort (N = 130).

Key data: A total of 23 international experts developed a set of 17 QIs covering diagnosis, treatment, LN monitoring, and reproductive health. High adherence (≥80%) was observed for kidney biopsy (93.5%), hydroxychloroquine use (98.4%), maintenance immunosuppression (85.4–87.8%), appropriate switching between immunosuppressive agents (100%), renin-angiotensin-aldosterone system (RAAS) blockade utilization (81.0%), remission before kidney transplantation (100%), and management during pregnancy (82.5–100%). Combination immunosuppressive therapy as initial treatment showed low adherence (10.7%), possibly reflecting historical practice patterns. High per-patient adherence was associated with significantly lower odds of damage accrual (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.13–0.62).

Key learning: These QIs offer a framework for integrating the 2025 EULAR recommendations for LN into clinical practice. Higher adherence to QIs was associated with reduced organ damage accrual, although external validation in multicenter cohorts is warranted.