What are the American College of Rheumatology guidelines for managing lupus nephritis?

Updated: Mar 04, 2019
  • Author: Lawrence H Brent, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The first guidelines for managing lupus nephritis have been issued by the American College of Rheumatology. [76] Key points of the guidelines are as follows:

  • Patients with clinical evidence of active, previously untreated lupus nephritis should have a renal biopsy to classify the disease according to International Society of Nephrology/Renal Pathology Society criteria

  • All patients with lupus nephritis should receive background therapy with hydroxychloroquine, unless contraindicated; this recommendation was based on a prospective controlled trial showing lower flare rates in those who continued hydroxychloroquine, compared with those who switched to placebo [77]

  • Glucocorticoids plus either cyclophosphamide intravenously (IV) or mycophenolate mofetil orally for induction in patients with ISN class III/IV disease; patients with ISN/RPS class I and II nephritis do not require immunosuppressive therapy

  • Administer ACEIs or ARBs if proteinuria is 0.5 g/24 h or more

  • Maintain blood pressure at or below 130/80 mm Hg


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