Lupus nephritis therapy reference (2026)

Lupus nephritis therapy in 2026 organises around induction and maintenance.

Induction therapy: corticosteroids plus an immunosuppressant. The standard immunosuppressant options are mycophenolate mofetil or intravenous cyclophosphamide. Recent practice combines either of these with a third agent (belimumab or voclosporin) for additional renal-response benefit.

Maintenance therapy: mycophenolate at lower dose or azathioprine, with continued belimumab in patients started on it during induction. Hydroxychloroquine is recommended for nearly all SLE patients including those with lupus nephritis.

Refractory disease: rituximab is widely used off-label and obinutuzumab (anti-CD20) is in pivotal data with the proposition of more complete B-cell depletion. CD19 CAR-T cell therapy (covered in earlier rounds for refractory autoimmune disease broadly) has growing reports of durable remission in lupus including lupus nephritis.

The diagnostic-and-monitoring pathway is integral. Renal biopsy at presentation defines class and severity; serial urine protein, creatinine, and complement monitoring guide therapy adjustment. The complete renal response endpoint at 12 months is the standard outcome measure.