Lecture Code : GL01-S2
Session Name : Glomerulonephritis
Session Topic : Glomerular and Tubulointerstitial Disorders
Date & Time, Place : June 20 (Fri) / 10:40-12:20 / Room 1 (GBR 101)

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Management of Refractory Lupus Nephritis Based on New Guideline

Sunhwa Lee
Kangwon National University Hospital, Republic of Korea

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Lupus nephritis (LN) develops in approximately 20% to 60% of patients with systemic lupus erythematosus (SLE), and renal involvement is associated with increased morbidity and mortality. In 2024, the Kidney Disease: Improving Global Outcomes (KDIGO) organization released updated guidelines for the management of LN, reflecting recent advances in clinical research. Compared to the 2021 recommendations, the 2024 update includes significant changes, particularly in the induction treatment of proliferative LN (Class III and IV). The revised guidelines now recommend biologic agents such as belimumab or calcineurin inhibitors (e.g., voclosporin) as first-line options for induction therapy. For patients with refractory disease or an inadequate response to initial standard-of-care therapy, several novel biologic and non-biologic agents are under investigation. Promising options include obinutuzumab, anifrolumab, belimumab, and voclosporin. In this lecture, we will review the key updates in the 2024 KDIGO lupus nephritis guidelines and examine the clinical evidence supporting these changes. We will also explore real-world cases of refractory lupus nephritis and discuss practical examples of how the aforementioned therapies are being applied in clinical practice.

Keywords: Lupus nephritis, refractory, update, rituximab, belimumab