2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis.
The 2024 ACR guideline for lupus nephritis reframes therapy as a continuous process rather than separate induction and maintenance phases, recommending pulse glucocorticoids followed by an oral taper plus two additional immunosuppressive agents for 3 to 5 years in patients achieving complete renal response.
Background
Lupus nephritis is a major driver of morbidity and kidney failure in systemic lupus erythematosus, and the expanding array of targeted therapies created a need for updated, evidence-based guidance on screening, treatment, and management. The American College of Rheumatology convened a panel to address these questions using a structured PICO and GRADE methodology.
Key recommendations
The guideline presents 28 graded recommendations (7 strong and 21 conditional) plus 13 ungraded, consensus-based good practice statements. Its unifying principle is that lupus nephritis therapy is continuous and ongoing rather than divided into discrete induction and maintenance phases. Recommended therapy includes pulse glucocorticoids followed by an oral glucocorticoid taper combined with two additional immunosuppressive agents, continued for 3 to 5 years in patients who achieve a complete renal response.
Clinical implications
Clinicians are directed toward early combination immunosuppression, rapid glucocorticoid minimization, and sustained treatment to protect kidney function. The panel emphasizes that these recommendations should guide rather than restrict care, with treatment decisions individualized to each patient's clinical situation and preferences.
Category
Guidelines
Source
Arthritis Rheumatol
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.