KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis

The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis (LN). The management of LN has become increasingly individualized, and treatment options are expanding; for example, since the release of the KDIGO guideline, the US Food and Drug Administration has approved obinutuzumab in addition to belimumab and voclosporin for the treatment of LN, and the enrollment of patients in chimeric antigen receptor (CAR) T-cell therapy clinical trials is changing the treatment landscape for autoimmune diseases including systemic lupus erythematosus. The use of combination therapy and the trend toward lower doses of corticosteroids for LN management are also part of this transformation. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provides perspectives for implementation within the context of clinical practice in the United States. This commentary is the product of the KDOQI work group and presents the recommendations and practice points from the KDIGO guideline, followed by commentary and brief notes on clinical utility, implementation, and challenges.