Lupus nephritis is an immune complex mediated glomerulonephritis representing one of the most severe manifestations of systemic lupus erythematosus. Despite advances in therapy, progression to chronic kidney disease remains significantly high, underlining the need for more effective drug regimens that encompass less long-term toxicity. Recently, lupus nephritis has been reframed as a form of chronic kidney disease, shifting therapeutic goals toward three main pillars: sustained immunological control with prevention of relapse, interventions that target non-immune factors of chronic kidney disease and strategies that minimize infection risk. The emergence of novel therapeutic agents has prompted updates of major international guidelines, with new combination drug schemes that increase efficacy and allow glucocorticoid sparing. This position statement reviews the KDIGO 2024, ACR 2024, and EULAR 2025 recommendations and presents the Immunophenology Working Group of the Portuguese Society of Nephrology perspective on the management of proliferative Lupus nephritis - Classes III and IV, according to our national context.
Nogueira et al. (Sat,) studied this question.