ACR Screening, Treatment, and Management of Lupus Nephritis Guideline Summary

Diagnosis

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.

The ACR recommends that all SLE patients with nephritis be treated with a background of hydroxychloroquine (HCQ). (C)