Screening, Treatment, and Management of Lupus Nephritis

Publication Date: May 3, 2012
Last Updated: September 2, 2022

Diagnosis

Case Definition for Lupus Nephritis (LN)

  • For the purpose of these recommendations, LN is defined as clinical and laboratory manifestations that meet American College of Rheumatology (ACR) criteria (persistent proteinuria >0.5 gm per day or >3+ by dipstick, and/or cellular casts including red blood cells [RBCs], hemoglobin, granular, tubular, or mixed).
  • A spot urine protein/creatinine ratio of >0.5 can be substituted for the 24-hour protein measurement.
  • “Active urinary sediment” (>5 RBCs/high-power field [hpf], >5 white blood cells [WBCs]/hpf in the absence of infection, or cellular casts limited to RBC or WBC casts) can be substituted for cellular casts.
  • An additional, perhaps optimal, criterion is a renal biopsy sample demonstrating immune complex–mediated glomerulonephritis compatible with LN.
  • A diagnosis of LN should also be considered valid if based on the opinion of a rheumatologist or nephrologist.

Treatment

Adjunctive Treatments

The ACR recommends that all SLE patients with nephritis be treated with a background of hydroxychloroquine (HCQ). (C)
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All LN patients with proteinuria ≥0.5 gm per 24 hours (or equivalent by protein/creatinine ratios on spot urine samples) should have blockade of the renin–angiotensin system, which drives intraglomerular pressure. (A)
(A for nondiabetic chronic renal disease)
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The ACR recommends that careful attention be paid to control of hypertension, with a target of ≤130/80 mm Hg. (A)
(A for nondiabetic chronic renal disease)
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The ACR also recommends that statin therapy be introduced in patients with low-density lipoprotein cholesterol >100 mg/dL. (C)
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The ACR recommends that women of child-bearing potential with active or prior LN receive counseling regarding pregnancy risks conferred by the disease and its treatments. (C)
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Overview

Title

Screening, Treatment, and Management of Lupus Nephritis

Authoring Organization

American College of Rheumatology