Comparative Analysis of Lupus Nephritis Guidelines: ACR 2025, EULAR 2025, and Kdigo 2024.
The ACR 2025, EULAR 2025 and KDIGO 2024 lupus nephritis recommendations rest on a largely shared evidence base but differ in scope, clinical profiling and operational emphasis, while converging on early combination therapy, rapid glucocorticoid minimisation and renoprotection.
Background
Lupus nephritis is a major driver of morbidity and kidney failure in systemic lupus erythematosus, and its management has become substantially more complex with the emergence of targeted therapies. Between 2024 and 2025 the American College of Rheumatology, the European Alliance of Associations for Rheumatology, and Kidney Disease: Improving Global Outcomes each released updated recommendations.
Scope of the comparison
This review compares the three frameworks side by side, highlighting the key areas of convergence and divergence relevant to contemporary clinical practice. Although the three groups drew on a largely shared evidence base, they differ in scope, in how they use clinical profiling, and in operational emphasis.
Key themes
Four themes dominate across the three documents: a shift toward early combination regimens that target complementary immune pathways, driven by the availability of targeted therapies such as belimumab, voclosporin and obinutuzumab; the incorporation of clinical profiling to guide therapy selection and monitoring; strategies aimed at rapid glucocorticoid minimisation; and the growing recognition of renoprotective therapy as a central pillar of lupus nephritis care within a broader chronic kidney disease management strategy.
Clinical implications
Clinicians following more than one of these guidelines should expect agreement on the overall direction of travel — earlier combination immunosuppression, less glucocorticoid, and formal renoprotection — but should be aware that the frameworks differ in scope and in the operational detail of how therapy is selected and monitored. The review is intended as a map of where those differences lie rather than as a new set of recommendations.
Category
KDIGO
Source
Nephrol Dial Transplant
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