The American College of Rheumatology (ACR) recently released updated guidelines for the screening, treatment and management of lupus nephritis (LN), lupus-related kidney disease, to offer best practices for clinicians and individuals with LN. This full publication of the guidelines comes following the guideline summary released in November at the ACR Convergence 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 guidelines. The two strongest themes from 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 6-12 months to detect kidney involvement
- A kidney biopsy may be needed if urine and blood test indicate kidney involvement to guide treatment.
- Treatment Strategies
- A preferred approach for treating LN involving using triple therapy, which includes intravenous glucocorticoids followed by a combination of mycophenolic acid (MPAA), belimumab, low dose cyclophosphamide or calcineurin inhibitors like tacrolimus or voclosporin.
- Implementing a reduced-dose glucocorticoid strategy (following the initial intravenous pulse) to reduce toxicity, aiming for a prednisone target of ≤5 mg/day within six months of treatment.
- Ongoing treatment for 3-5 years to sustain kidney health and prevent relapses, with regular monitoring for early detection of flare-ups.
- 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.
Overall, the guideline recognizes the key role of clinical rheumatologists in managing LN. While lupus nephritis therapies are continuous and ongoing, these new guidelines lay the groundwork for close working relationships between rheumatologists and nephrologists leading to more personalized care and a better quality of life for those living with LN. Learn more about lupus nephritis.
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