At the ACR Convergence 2024, Dr Bella Mehta expounds on how the new guidelines for lupus nephritis emphasize a shift toward more aggressive management and frequent monitoring. For patients with systemic lupus erythematosus and no known lupus nephritis, proteinuria should be checked every 6-12 months, or during clinical flares. For those with known lupus nephritis, monitoring should be more frequent — every 3 months if not in remission, and every 3-6 months if in remission. The guidelines also stress the importance of kidney biopsy if lupus nephritis is suspected, especially after starting glucocorticoids or during disease flares and treatment failures.
In terms of treatment, Dr Mehta also notes that the guidelines now prioritize triple therapy (glucocorticoids, mycophenolate analogs, and either belimumab or calcineurin inhibitors) over previous dual therapies, based on results from the BLISS-LN and AURORA 1 trials. The guidelines also focus on minimizing steroid use, and for refractory cases, treatments such as rituximab or switching to alternative therapies are advised. Regular follow-up with a rheumatologist is crucial, because treatment for lupus nephritis typically spans 3-5 years.
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Cite this: ACR 2024: Key Insights on Updated Lupus Nephritis Guidelines - Medscape - Nov 25, 2024.
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