Guidance for Lupus Nephritis Management

The 13 good practice statements in the ACR’s guideline on lupus nephritis offer recommendations on patient adherence, pediatric appropriate doses of medications and the assessment of treatment plans for older patients, among other critical topics. These recommendations should not be used to limit or deny access to therapies because treatment decisions may vary due to the unique clinical situation and personal preferences of each individual patient.

Which of the following is not a good practice statement contained in the guideline?

A. Medication dose and patient adherence should be assessed regularly throughout the course of treatment as an important first step in evaluating inadequate response or refractory lupus nephritis because insufficient treatment is a key cause of non-response.

B. Alternative etiologies of kidney dysfunction in people with SLE don’t need to be excluded because noninflammatory etiologies, such as hypertensive, diabetic and medication-induced nephropathy, are rare.

C. In children with childhood-onset SLE (cSLE) nephritis, glucocorticoid regimens should use pediatric appropriate doses for children because reduction of cumulative glucocorticoid dosing is critically important given the early age of cSLE onset and attendant comorbidities.

D. For older people with lupus nephritis, medication number, type and dosage should be regularly assessed, given the risks of polypharmacy and age-related decline in GFR in this population.