The 2024 ACR guidelines introduce important updates for the screening, treatment, and monitoring of lupus nephritis, with a focus on preserving renal function, reducing chronic kidney disease morbidity, and minimizing medication-related toxicities. In this video, Lisa Asfahani, PA-C, a rheumatology expert with over 11 years of experience, breaks down these new recommendations.
She discusses the importance of screening all lupus patients every 6 to 12 months, as 30-50% of SLE patients eventually develop lupus nephritis. The updated guidelines recommend renal biopsy for patients with significant proteinuria or unexplained impaired renal function. For Class 3 and Class 4 lupus nephritis, a triple immunosuppressive regimen is conditionally recommended, which may include glucocorticoids, mycophenolate, belimumab, calcineurin inhibitors, or cyclophosphamide. For Class 5 lupus nephritis with proteinuria greater than 1 g/g, triple therapy involving glucocorticoids, mycophenolate, and a calcineurin inhibitor is recommended. The guidelines also emphasize low-dose steroid tapering to minimize toxicity, starting with 0.5 mg/kg/day of prednisone and tapering to ≤5 mg/day by six months.
Additionally, new strong recommendations for monitoring include assessing proteinuria every three months in patients without complete renal response and every three to six months in those with sustained complete renal response.
Stay updated on the latest evidence-based approaches to managing lupus nephritis with these 2024 ACR guidelines. For more educational content please visit RhAPP.org or download the RhAPP ACE 2.0 app.
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