Abstract
<jats:p>Lupus nephritis (LN) is one of the most significant manifestations of systemic lupus erythematosus (SLE), affecting approximately 35%–40% of patients in large cohort studies. It is usually diagnosed in the early phases of the disease; among those with LN, approximately 80% are diagnosed at or shortly after disease onset. LN is characterized by histological and clinical heterogeneity and substantially affects survival. A meta-analysis of 18,309 LN patients reported a 10-year risk for the development of end-stage kidney disease (ESKD) of nearly 17% overall and 33% among those with LN class IV (diffuse proliferative form). Early detection and timely management are essential for optimizing outcomes. Herein, we present a step-by-step approach to the current management of adult LN as recommended by the 2024 American College of Rheumatology (ACR), the 2025 updated European Alliance of Associations for Rheumatology (EULAR), as well as the 2024 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. New treatment options that are currently under investigation are also discussed briefly.</jats:p>