How Long Has It Been Since the Last ACR LN Guideline Updates and Why Is This Significant?

Join Amanda Mixon, PA-C, a physician assistant in Northern Colorado and President of RhAPP, as she unpacks the latest ACR guidelines for lupus nephritis. These updates mark a major shift in treatment, incorporating new therapies that enhance disease management while reducing medication toxicity.

Previous guidelines relied heavily on high-dose steroids with mycophenolate mofetil (MMF) or cyclophosphamide for induction, followed by MMF maintenance. Now, with the approval of belimumab and voclosporin, treatment strategies emphasize a more targeted and sustained approach. These new options help preserve kidney function while limiting steroid exposure.

The revised recommendations call for a lower-dose glucocorticoid regimen, starting at 0.5 mg/kg per day (max 40 mg) with tapering to 5 mg daily within six months. For Class III and IV lupus nephritis, triple therapy—including glucocorticoids, MMF, and belimumab or a calcineurin inhibitor—is now preferred. In Class V cases with significant proteinuria, MMF and a calcineurin inhibitor remain key components.

Frequent monitoring, particularly urine protein assessments, is crucial for tracking disease progression and preventing irreversible kidney damage. With these updates, clinicians have clearer guidance on optimizing lupus nephritis care while minimizing long-term complications.

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