Awareness of specialists about morbidity and treatment of lupus nephritis in Bulgaria: A feasibility study

A qualitative, non-interventional inquiry study was conducted to evaluate current practices and challenges in the management of systemic lupus erythematosus (SLE) and lupus nephritis (LN). A structured questionnaire consisting of 17 questions was administered to rheumatologists and nephrologists. The survey explored the frequency of LN among patients with SLE, standards and duration of care, treatment protocols, disease characteristics associated with complications and staging, the use of biological therapies, treatment gaps, opportunities for improvement, and the extent of multidisciplinary collaboration. Responses were systematically analyzed using descriptive statistical and narrative synthesis methods. The findings indicate that approximately 4,050 patients are diagnosed with SLE, corresponding to a relatively low diagnosis rate of 0.72%. Among the specialists surveyed, 35% identified LN as the most common complication affecting patients with SLE. All respondents agreed that delayed initiation of therapy is associated with an increased risk of complications, particularly LN. Considerable variability was reported in the prevalence of advanced LN stages (III–V), although estimates generally ranged between 10% and 70%, suggesting that a substantial proportion of patients progress to severe disease. Current treatment strategies rely predominantly on immunosuppressive therapies; however, respondents highlighted a significant need for more targeted treatment options. Approximately 25% of patients who are resistant to conventional therapies may be candidates for biological treatments, which are generally well tolerated. Rheumatologists primarily manage the early and systemic manifestations of SLE, while nephrologists play a central role in advanced LN management and kidney biopsy procedures. The study identified unmet needs related to delayed diagnosis, limited access to biologic therapies, and a lack of novel therapeutic options. Strengthening multidisciplinary collaboration and establishing specialized centers may improve patient outcomes and support more personalized, patient-centered care.