Good Practice Statements - The Rheumatologist

From medication dosages to adjunctive treatments, the ACR’s guideline on lupus nephritis in children and adults includes good practice statements regarding a broad range of screening, treatment and management considerations. 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. Glucocorticoid treatment should be withheld until a kidney biopsy and the histopathology results confirm a diagnosis of lupus nephritis.

B. Prompt percutaneous kidney biopsy should be performed in people with systemic lupus erythematosus when lupus nephritis is suspected (unless contraindicated or not feasible), as histopathologic biopsy features will confirm the diagnosis, rule out mimicking diseases and impact therapy decisions.

C. Dosage of lupus nephritis medications should be adjusted in people with decreased glomerular filtration rate at the initiation of therapy and periodically as indicated during the disease course.

D. Adjunctive treatment with systemic anticoagulation for people with lupus nephritis and significant risk factors for thrombosis (e.g., low serum albumin in the context of severe proteinuria) should be discussed with nephrology.