Advancing Care in Lupus Nephritis: Expert Perspectives on Current Practices and Future Directions in Italy

Background: Lupus nephritis (LN), a major complication of systemic lupus erythematosus, remains a key determinant of morbidity and mortality despite therapeutic progress. Objective: An expert report aims to present multidisciplinary insights from leading Italian centers on current LN management and future perspectives. Methods: Seven specialists-including nephrologists and rheumatologists with expertise in lupus nephritis-addressed key aspects of LN management, including treatment goals, available therapeutic options, treatment selection across disease stages, and emerging strategies. Results: The authors highlight evolving treatment paradigms-shifting from traditional induction-maintenance strategies to early combination regimens integrating biologics such as belimumab and calcineurin inhibitors like voclosporin-aligned with updated EULAR and KDIGO guidelines. Regional experiences underscore individualized therapy tailored by histology, disease activity, and patient profile. Multidisciplinary collaboration between nephrologists and rheumatologists, equitable access to innovative therapies, and integration of registries and digital records are identified as priorities. Conclusions: Emerging agents, including obinutuzumab, anifrolumab, and CAR-T cell therapies, represent promising advances toward steroid-sparing and potentially curative strategies. Continued research, biomarker development, and application of artificial intelligence are pivotal to optimizing outcomes and achieving personalized LN management.