Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany.
Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
Department of Nephrology, Limassol General Hospital, State Health Services Organization, Kato Polemidia, Cyprus; University of Nicosia Medical School, Engomi, Cyprus; Department of Nephrology, Aretaieion General Hospital, National Kapodistrian University of Athens, Greece.
Division of Rheumatology, Northwell Health, Great Neck, New York, USA.
Lupus Program, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
Cyprus League Against Rheumatism, Aglantzia, Cyprus.
Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Nephrology Unit, Hospital Fernandez, Buenos Aires, Argentina.
Nephrology Department and Renal Transplantation Unit, "Laikon" Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Department of Medicine, Tuen Mun Hospital, Hong Kong, China.
Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, and Center for Molecular Medicine (CMM), Stockholm, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Rheumatology, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Complejo Asistencial Universitario de León (Rheumatology), León, Spain; University of León, León, Spain.
Epidemiology Research Unit, Italian Society of Rheumatology, Milan, and School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Centre of expertise for Lupus-, Vasculitis- and Complement-mediated Systemic autoimmune diseases, Department of Internal Medicine - section Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National Kapodistrian University of Athens, Greece; Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece; Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
OBJECTIVES: The objective of this study was to update the 2019 European Alliance of Associations for Rheumatology (EULAR)/ European Renal Association/European Dialysis Transplantation Association (ERA-EDTA) recommendations for the management of systemic lupus erythematosus (SLE) with kidney involvement, taking into consideration emerging evidence and recent developments in the field.
METHODS: We recruited an international Task Force of experts and followed the EULAR standard operating procedures. We performed systematic literature research (period January 2019 to March 2024), followed by the modified Delphi method, to form questions, elicit expert opinions, and reach consensus. The new evidence was examined, taking into consideration previous updates.
RESULTS: The Task Force agreed on 4 overarching principles and 13 recommendations, which were also evaluated for their feasibility and impact on clinical care. These concern the use of kidney biopsy for diagnosis; targets of therapy and treatment milestones; immunomodulatory therapy with antimalarials, glucocorticoids, immunosuppressives (mycophenolate, cyclophosphamide, and calcineurin inhibitors), and biologics (belimumab, obinutuzumab, and rituximab); nonimmune therapy (kidney protection, vaccinations, cardiovascular, and bone protection); family planning; and management of kidney failure. Guidance on single-agent or early combination immune therapy, glucocorticoid tapering and withdrawal, duration of immune therapy, and treatment of refractory disease is provided.
CONCLUSIONS: The updated EULAR recommendations provide evidence- and expert-based consensus on the management of SLE with kidney involvement, adjusted for severity, and taking into consideration long-term efficacy, safety, cost, and local availability of drugs.
Elsevier, 2025. article id S0003-4967(25)04412-7