New Treatment Guideline for Lupus Nephritis Shifts Focus to Continuous Therapy

The American College of Rheumatology (ACR) has released an updated guideline for the screening, treatment and management of lupus nephritis (LN), a lupus-related kidney disease, to offer best practices for clinicians and individuals with LN. The full publication of the guideline  (Arthritis Care Res [Hoboken] 2025 Mar 24. doi:10.1002/acr.25528) comes following the guideline summary released in November at the ACR Convergence 2024 conference. 

A total of 28 graded and 13 ungraded recommendations for good-practice statements for the screening and management of LN were developed. A patient panel, partially recruited from the Lupus Foundation of America’s Research Accelerated by You (RAY) registry, also contributed to the development of the guideline. The  study found that shared decision-making and clinician acknowledgment of treatment burden are most important to managing the disease in adults and children with LN.

The guideline proposes:
• early detection and diagnosis;
• regular urine protein tests every six to 12 months to detect kidney involvement; and 
• a kidney biopsy may be needed if urine and blood tests indicate kidney involvement to guide treatment.

A preferred approach for treating LN involves:
• using triple therapy, which includes IV glucocorticoids followed by a combination of belimumab (Benlysta, GSK), calcineurin inhibitors such as tacrolimus or voclosporin (Lupkynis, Aurinia), low-dose cyclophosphamide, or mycophenolic acid;
• implementing a reduced-dose glucocorticoid strategy (following the initial IV pulse) to reduce toxicity, aiming for a prednisone target of no more than 5 mg per day within six months of treatment; and 
• ongoing treatment for three to five years to sustain kidney health and prevent relapses, with regular monitoring for early detection of flare-ups; and
• considerations specific to pediatrics regarding the impact of glucocorticoids on growth and pubertal development.

Other recommendations include blood pressure control, taking precautions to reduce infection and early evaluation for kidney transplantation, if necessary.


Based on a press release from the ACR.