New age of Lupus Nephritis: Updates in guidelines, biomarkers, and therapies

Lupus nephritis (LN) is the most common visceral organ manifestation of systemic lupus erythematosus (SLE). It affects approximately 50% of SLE patients, accounting for significant morbidity and mortality especially in ethnic minorities. Building on decades of landmark trials, the field has continued to evolve. The 2024 American College Rheumatology (ACR) Lupus Nephritis guideline represents an important shift toward earlier triple therapy. The guideline also recommends routine proteinuria screening and reaffirms kidney biopsy as the diagnostic gold standard. In parallel, urinary biomarkers are emerging as potential tools to better track infrarenal pathology. Furthermore, the therapeutic pipeline continues to expand with emerging strategies targeting B-cells, cytokine receptors, and co-stimulatory mechanisms. In this article, we review updates from the ACR guideline, the emerging data on urinary biomarkers, and highlight novel targeted therapies in LN.