Tahereh Yavari: 2025 EULAR Update – Redefining Lupus Nephritis Management
Tahereh Yavari, Assistant professor of internal medicine at Tehran University of Medical Sciences (TUMS), shared a post on LinkedIn:
“2025 EULAR Update: Redefining Lupus Nephritis Management
The European Alliance of Associations for Rheumatology (EULAR) has just released its 2025 recommendations for the management of Systemic Lupus Erythematosus (SLE) with kidney involvement, led by Antonis Fanouriakis et al.
This update reflects a paradigm shift in how we approach lupus nephritis (LN) — integrating precision immunotherapy, treat-to-target, and shared decision-making principles.
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What’s New in the 2025 EULAR Guidance
1. Early, biopsy-based stratification:
Renal biopsy remains central — guiding both class-specific and activity/chronicity-driven treatment decisions. Repeat biopsy is encouraged in relapsing or refractory disease.
2. Triple therapy endorsed for active Class III/IV ± V LN:
• Glucocorticoid (low-dose, rapidly tapered)
• Mycophenolate mofetil or low-dose IV cyclophosphamide
• Add-on biologic: belimumab or voclosporin recommended as part of the initial regimen.
3. Maintenance therapy evolution:
Tacrolimus, azathioprine, or mycophenolate remain standards — but now, biologic continuation (esp. belimumab) is acceptable for sustained control and flare prevention.
4. Treatment goals:
Aim for proteinuria < 0.5 g/day and eGFR stabilization by 12 months — consistent with EULAR’s treat-to-target philosophy.
5. Beyond immunosuppression:
Multidisciplinary care, BP control (ACEi/ARB first-line), lipid and bone health, and pregnancy-safe planning are emphasized as equal pillars of LN care.
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Clinical Takeaway
Lupus nephritis management is entering an era of combination precision therapy —
- Early targeted immunomodulation instead of stepwise escalation,
- Less steroid exposure,
- Integration of biologics from the start, and
- Continuous renal and serologic monitoring toward individualized remission.
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Fanouriakis A, Kostopoulou M, et al. EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update.”
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