#3-29E. A Paradigm Shift in Lupus Nephritis: The EULAR 2025 Recommendations (Ann Rheum Dis, 2026)

How has the standard of care for lupus nephritis evolved beyond traditional monotherapy? This episode explores the pivotal "EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update." This comprehensive guideline marks a significant departure from previous protocols by strongly advocating for early combination therapy—pairing mycophenolate or cyclophosphamide with belimumab, calcineurin inhibitors like voclosporin, or obinutuzumab—for active nephritis. Additionally, it formally elevates the role of non-immune kidney protection, specifically recommending SGLT2 inhibitors to delay disease progression. The key clinical takeaway is the fundamental shift towards aggressive, multi-target intervention to optimize renal response and preserve nephrons. However, while critical, listeners should note that some recommendations regarding specific patient subgroups rely on post-hoc analyses of major trials and expert consensus rather than direct head-to-head comparisons. For clinicians, this paper is indispensable, providing a modern, evidence-based framework to improve long-term renal survival and minimize chronic kidney disease in SLE patients.

Citation: Fanouriakis A, et al. EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update. Ann Rheum Dis. 2026. DOI: 10.1016/j.ard.2025.09.007

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.