The management of lupus nephritis as proposed by EULAR/ERA 2019 versus KDIGO 2021

Hans Joachim Anders, Jerome Loutan, Annette Bruchfeld, Gema M. Fernández-Juárez, Jürgen Floege, Dimitrios Goumenos, Kultigin Turkmen, Cees van Kooten, Eleni Frangou, Kate I. Stevens, Andreas Kronbichler, Mårten Segelmark, Vladimir Tesar

Research output: Contribution to journalArticlepeer-review


In 2019 and 2021, the European League for Rheumatism (EULAR) jointly with the European Renal Association (ERA) and the Kidney Disease: Improving Global Outcomes (KDIGO), respectively, released updated guidelines on the management of lupus nephritis (LN). The Immunology Working Group of the ERA reviewed and compared both updates. Recommendations were either consistent or differences were of negligible clinical relevance for: indication for kidney biopsy, kidney biopsy interpretation, treatment targets, hydroxychloroquine dosing, first-line initial immunosuppressive therapy for active class III, IV (±V) LN, pregnancy in LN, LN in paediatric patients and LN patients with kidney failure. Relevant differences in the recommended management relate to the recognition of lupus podocytopathies, uncertainties in steroid dosing, drug preferences in specific populations and maintenance therapy, treatment of pure class V LN, therapy of recurrent LN, evolving alternative drug options and diagnostic work-up of thrombotic microangiopathy. Altogether, both documents provide an excellent guidance to the growing complexity of LN management. This article endeavours to prevent confusion by identifying differences and clarifying discrepancies.

Original languageEnglish
Pages (from-to)551-561
Number of pages11
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Issue number3
Publication statusPublished - 2023 Feb 28

Bibliographical note

Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.

Subject classification (UKÄ)

  • Urology and Nephrology

Free keywords

  • autoimmunity
  • glomerulonephritis
  • inflammation
  • lupus
  • standards


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