09 Managing lupus nephritis

Abstracts, pp. A5.2–A6

Abstract

Lupus nephritis (LN) remains one of the most severe organ manifestations of systemic lupus erythematosus, affecting up to 50% of patients and carrying substantial risk of progressive renal failure despite modern immunosuppressive therapy. This workshop provides a structured, state-of-the-art update spanning the full clinical spectrum of LN — from foundational concepts to emerging treatment paradigms.The workshop opens with a review of the pathological and clinical basis of LN, including the updated ISN/RPS classification, renal biopsy interpretation, histopathological activity and chronicity indices, and the evolving role of repeat biopsies in guiding therapeutic decisions. Key epidemiological data and disease course trajectories will be contextualized to inform clinical decision-making. Building on this foundation, the workshop will address the frequently underrecognized burden of non-immune chronic kidney disease progression in LN patients — a critical determinant of long-term renal outcomes that extends beyond immunological disease activity. Nephroprotective strategies and their integration into holistic LN management will also be discussed.1The immunosuppressive treatment landscape will be reviewed through the lens of the current American College of Rheumatology treatment guideline, with a focus on the evidence supporting a triple-immunosuppressive therapeutic approach with voclosporin and belimumab as guideline-endorsed therapies, and their role in achieving deeper, more durable remission.2 The updated European Alliance of Associations for Rheumatology recommendations will also be reviewed.3The workshop will conclude with an in-depth evaluation of B-cell depleting strategies, including rituximab, obinutuzumab, and combination approaches targeting the B-cell axis, followed by an integrative perspective on disease modification as an overarching treatment goal — reframing LN management beyond remission induction toward sustained organ protection and immune re-education.4Learning Objectives Interpret renal biopsy findings within the current LN classification framework and apply this to treatment selection and monitoring.Discuss the mechanisms and clinical relevance of non-immune CKD progression in LN patients and identify nephroprotective interventions.Apply updated guideline recommendations, including the role of voclosporin and belimumab, to individualise a triple immunosuppressive therapeutic approach.Evaluate optimised B-cell depleting strategies — including rituximab, obinutuzumab, and combination regimens — based on emerging clinical evidence.Articulate the concept of disease modification in LN as a framework for long-term management beyond conventional treat-to-target endpoints.References Teng YKO, Frangou E, Kronbichler A, et al. Disease-modifying anti-nephropathic drugs (DMANDs)-a definition proposed by the immunonephrology working group (IWG) of the European renal association (ERA). Nephrol Dial Transplant. 2025;40(6):1243–47. doi: 10.1093/ndt/gfaf033.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 Rheumatol. 2025;77(9):1115–35. doi: 10.1002/art.43212.Fanouriakis A, Kostopoulou M, Anders HJ, et al. EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update. Ann Rheum Dis. 2026;85(1):75–90. doi: 10.1016/j.ard.2025.09.007.Stockfelt M, Teng YKO, Vital EM. Opportunities and limitations of B cell depletion approaches in SLE. Nat Rev Rheumatol. 2025;21(2):111–26. doi: 10.1038/s41584-024-01210-9.

Authors 2

1. Maria Dall’Era

   University of California, San Francisco

   Affiliation as printed

   University of California, San Francisco, USA

2. Onno YK Teng Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, The Netherlands