Lupus nephritis occurs in up to 45% of patients with SLE. Clinical signs may be subtle or silent despite significant damage to the kidneys.1-6
Patients with lupus nephritis are at risk of nephron loss, kidney failure, and premature death. Early diagnosis and treatment are essential to improving outcomes.6-10
Evidence shows that even a single episode of LN can potentially shorten the life span of the kidneys by decades7
Subsequent episodes can cause cumulative damage, further shortening kidney survival7,10
Reprinted by permission from Copyright Clearance Center: Nature, Nat Rev Dis Primers, Lupus nephritis, Anders HJ, et al, 2020.
In an analysis of patients with SLE, patients with LN had6*:
*Adjusting for gender, age at enrollment, and race/ethnicity, a Cox regression analysis on the competing risks of kidney failure and death, with the diagnosis of LN used to define a time-dependent covariate.
CV complications contribute to increased mortality in patients with LN11
In a study of 1644 patients with SLE, LN was associated with an approximately 5x greater risk of CV-related death11
Delayed diagnosis can have severe consequences12
Though LN may occur in any patient with SLE, the risk is higher in6:
• Those with Black, Asian, and Hispanic ancestry
• Younger adults
LN can shorten kidney survival, and delayed diagnosis increases risk7,12
CKD=chronic kidney disease; CV=cardiovascular; GFR=glomerular filtration rate; LN=lupus nephritis; MI=myocardial infarction; SLE=systemic lupus erythematosus.
The key to good outcomes is active surveillance to identify and diagnose LN early
LN is not always clinically obvious—early detection and diagnosis require active surveillance1-3
*Males, juvenile lupus onset, serologically active disease.5
Early diagnosis of LN can improve outcomes. However, too few patients are being screened as recommended6,7
• Only 42% of patients were tested for LN† every 6 months‡
• Only 67% of patients received kidney biopsy within 1 year of suspected LN‡
†Urinalysis, UPCR, and SCr.
‡Study evaluated 250 participants across a variety of clinical settings enrolled in the California Lupus Epidemiology Study (CLUES), with the goal of identifying gaps in quality of care for screening, diagnosing, and treating LN.7
The 2019 EULAR/ERA-EDTA guidelines for LN emphasize the importance of active surveillance to identify and treat LN early1,5
The 2019 EULAR/ERA-EDTA Guidelines for LN Recommend More Frequent Screening in Populations at Higher Risk and Expand Criteria for Biopsies as Compared With the 2012 ACR Guidelines1,5,8
Better outcomes for patients with LN start with active surveillance and early diagnosis1,5
ACR=American College of Rheumatology; ERA-EDTA=European Renal Association-European Dialysis and Transplant Association; EULAR=European League Against Rheumatism; GFR=glomerular filtration rate; LN=lupus nephritis; SCr=serum creatinine; SLE=systemic lupus erythematosus; UPCR=urine protein-to-creatinine ratio.
Recent guidelines encourage an immediate proteinuria reduction
Recent guidelines provide definitive treatment targets to optimize outcomes1
*Patients with nephrotic-range proteinuria at baseline may require an additional 6 to 12 months of treatment to reach complete clinical response; in such cases, prompt switches of therapy are not necessary if proteinuria is improving.2
Early decreases in proteinuria levels are highly predictive of better long-term outcomes2
In a retrospective analysis, 10-year patient and kidney survival were significantly better in patients who achieved complete response (P<0.0001)3
Partial response also improved outcomes
Reprinted by permission from Copyright Clearance Center: American Society of Nephrology, Clin J Am Soc Nephrol, Value of a complete or partial remission in severe lupus nephritis, Chen YE, et al, 2008.
The 2019 EULAR/ERA-EDTA guidelines for LN emphasize the importance of active surveillance to identify and treat LN early1,4
The 2019 EULAR/ERA-EDTA Guidelines for LN Recommend Specific Treatment Targets as Compared With the 2012 ACR Guidelines1,4,5
ACR=American College of Rheumatology; AZA=azathioprine; BL=baseline; CR=complete response; CYC=cyclophosphamide; ERA-EDTA=European Renal Association‐European Dialysis and Transplant Association; EULAR=European League Against Rheumatism; GFR=glomerular filtration rate; IV=intravenous; LN=lupus nephritis; MMF=mycophenolate mofetil; NR=no response; PR=partial response; SCr=serum creatinine; SLE=systemic lupus erythematosus; UPCR=urine protein‐to‐creatinine ratio.
Achieving early decreases in proteinuria can improve outcomes2
Register for important updates on LN
Even though LN is a challenging disease that can potentially shorten kidney life span and patients’ lives, significant progress over the past decade has led to a greater understanding of the disease and better ways to manage it.
The quest to improve the outlook for LN is ongoing. Research is focused on improving diagnostic and monitoring methods, and elucidating the pathophysiology of LN—all with the goal of diagnosing LN early, minimizing impact on kidney function, and improving long-term outcomes for every patient with LN.1
You are now registered to receive new information and resources to help meet the challenges of lupus nephritis.
Support for your patients: ALL IN™ for LN
To help support your patients with SLE with LN, ALL IN provides disease education, personal stories, helpful resources, and a way to connect to the LN community. Your patients can connect by visiting
LN=lupus nephritis; SLE=systemic lupus erythematosus.
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