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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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The management of lupus nephritis as proposed by EULAR/ERA 2019 versus KDIGO 2021

Hans-Joachim Anders1, Jerome Loutan1, Annette Bruchfeld2,3

  • 1Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Munich, Germany.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 10, 2021
PubMed

Insights

The European League for Rheumatism (EULAR) and Kidney Disease: Improving Global Outcomes (KDIGO) released updated lupus nephritis (LN) guidelines. While mostly consistent, key differences exist in managing lupus podocytopathies and specific treatment scenarios.

Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Updated lupus nephritis (LN) management guidelines were released in 2019 by EULAR/ERA and in 2021 by KDIGO.
  • These guidelines address the increasing complexity of managing LN, a significant autoimmune kidney disease.

Purpose of the Study:

  • To review and compare the 2019 EULAR/ERA and 2021 KDIGO guidelines for lupus nephritis management.
  • To identify and clarify discrepancies between the two sets of guidelines to aid clinical practice.

Main Methods:

  • Comparative analysis of recommendations from the EULAR/ERA (2019) and KDIGO (2021) lupus nephritis guidelines.
  • Focus on areas of consistency, negligible differences, and relevant distinctions in management strategies.

Main Results:

  • High consistency observed in recommendations for kidney biopsy indications, interpretation, treatment targets, hydroxychloroquine dosing, initial therapy for active LN, and management in pregnancy, pediatrics, and kidney failure.
  • Key differences identified in the recognition of lupus podocytopathies, steroid dosing, drug preferences, maintenance therapy, treatment of pure class V LN, recurrent LN, alternative drug options, and thrombotic microangiopathy work-up.

Conclusions:

  • Both guideline documents offer excellent guidance for lupus nephritis management.
  • Clarifying the identified differences is crucial to prevent confusion and ensure optimal patient care in complex LN cases.

Keywords:
autoimmunityglomerulonephritisinflammationlupusstandards

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