Treatment

Document Overview

Design and created by Guideline Central in participation with the American College of Rheumatology.

Screening, Treatment, and Management of Lupus Nephritis

American College of Rheumatology

Publication Date: May 7, 2025

Page Last Updated: May 5, 2026

Quality of Evidence and Strength of Recommendations

Quality of Evidence	Interpretation
High-quality evidence	Studies that provide high confidence in the effect estimate. New data from future studies are thought unlikely to change the effect.
Moderate-quality evidence	Studies that provide moderate confidence that the true effect is likely to be close to the estimate but possibly could be substantially different.
Low-quality evidence	Studies that provide limited confidence about the effect. The true effect may be substantially different from the estimate.
Very low-quality evidence	Studies that provide very little confidence about the effect. The true effect may be quite different from the estimate.
Strength of Recommendation	Interpretation
Strong recommendation	Supported by moderate- to high-quality evidence (e.g., multiple randomized controlled trials). Recommended course of action would apply to all or almost all patients. Only a small proportion of clinicians/patients would not want to follow the recommendation. In rare instances, a strong recommendation may be based on very low- to low-certainty evidence. For example, an intervention may be strongly recommended if it is considered benign, low-cost, without harms, and the consequence of not performing the intervention may be catastrophic. An intervention may be strongly recommended against if there is high certainty of more harm than the comparison with very low or low certainty about its benefit.
Conditional recommendation	Supported by lower-quality evidence or a close balance between desirable and undesirable outcomes. Recommended course of action would apply to the majority of the patients, but the alternative is a reasonable consideration. Conditional recommendations always warrant a shared decision-making approach, reflecting individual values and preferences.
Good practice statement	Good practice statements are made when panel members are confident that there is unequivocal benefit or harm despite indirect or inadequate evidence.
Ungraded Position Statement	Evidence for a PICO question did not support a graded recommendation or did not favor one intervention over the other; guidance for this question provided by the voting panel.

Adapted from: Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336 :924–6, and GRADE Working Group, list of GRADE working group publications and grants. Available at: https://www.gradeworkinggroup.org/publications.html.

Document Overview

Document Title: Screening, Treatment, and Management of Lupus Nephritis

Authoring Society: American College of Rheumatology

Document Publication Date: May 7, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: acrjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/art.43212

Source Citation: Sammaritano LR, Askanase A, Bermas BL, et al. 2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care Res (Hoboken). 2025 May 7. doi: 10.1002/acr.25528. Epub ahead of print. PMID: 40127995.

This article is published simultaneously in Arthritis Rheumatol. 2025 May 7. doi: 10.1002/ art.43212. Online ahead of print.PMID: 40331662.

Supplemental Implementation Resources

Summary

Document Scope, Criteria, and Use Cases

Document Objectives: The objective is to provide evidence-based and expert guidance for the screening, treatment, and management of lupus nephritis.

Scope: Assessment and Screening, Diagnosis, Treatment

Diseases/Conditions (MeSH)

D008181 - Lupus Nephritis

Keywords: lupus, lupus nephritis

Target Patient Population: adults with lupus nephritis (LN), particularly to those receiving care in the US

Target Provider Population: rheumatologists, nephrologists, and pathologists

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Screening, Treatment, and Management of Lupus Nephritis

Treatment

Screening

Kidney biopsy

Treatment of active LN (Class III/IV or Class V)

In people with active, new onset or flare of Class III/IV or Class V LN

In people with active, new onset, or flare of Class III/IV (with or without concomitant Class V) LN:

In people with active, new onset, or flare of (pure) Class V LN

Non-responsive or refractory LN

Other lupus kidney disease

Adjunctive/non-immunologic treatment

Monitoring LN activity

Renal replacement therapies

Quality of Evidence and Strength of Recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology