Expert insights on the 2024 ACR Guideline recommendations for lupus nephritis Save

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Apr 17, 2026 9:00 am

Managing lupus nephritis (LN) is complex, with high risks for progression and irreversible kidney damage.¹ The 2024 ACR Guideline offers important updates for treating and managing LN.²

To support you in understanding these recommendations, watch the 3-part video series, “Expert Insights & Case Review,” led by 2 recognized experts in lupus care.

Identifying lupus nephritis

See how ACR screening and diagnostic recommendations apply in a real-world setting.

ACR Guideline

SCREEN: For people with systemic lupus erythematosus, routine screening for proteinuria is recommended at least every 6 to 12 months, or more frequently during extra-renal flares.²
BIOPSY: When proteinuria exceeds a UPCR ratio of 0.5 g/g, prompt diagnostic evaluation, including a percutaneous kidney biopsy, is recommended.²

Consider escalating to triple immunosuppressive therapy after diagnosing LN.²

Treating lupus nephritis

Get insights on applying ACR treatment recommendations to a hypothetical patient.

ACR Guideline

TREAT: Triple immunosuppressive therapy is recommended across LN classes, except active pure class V. This includes glucocorticoids, mycophenolic acid analogs like mycophenolate mofetil (MMF), and an advanced therapy—either belimumab or a calcineurin inhibitor (CNI).² Among CNIs, voclosporin (LUPKYNIS®) has been the most extensively studied in U.S. clinical trials.^3,4
TAPER: Minimize steroid exposure, tapering to a maintenance dose of 5 mg/day or less within 6 months.²

Managing lupus nephritis long-term

See how experts monitor and adjust treatment over time.

ACR Guideline

MONITOR: Aim for complete renal response within 6 to 12 months. This is defined as a reduction in proteinuria to 0.5 g/g or less, along with stabilization or improvement in kidney function (±20% baseline).²
MANAGE: Continue therapy for 3 to 5 years to sustain remission and reduce the risk of relapse.²

LUPKYNIS is indicated in combination with a background immunosuppressive therapy regimen for the treatment of adult patients with active LN.⁴

LUPKYNIS: A treatment option that meets ACR Guideline recommendations^2-5

Proteinuria reduction

Patients taking LUPKYNIS were 81% more likely to achieve complete renal response at 1 year compared to patients taking MMF + low-dose steroids (LDS) alone (40.8% vs. 22.5%; P<0.001; OR: 2.7; 95% CI: 1.6 to 4.3).^4,a-c

LUPKYNIS reduced proteinuria to ≤0.5 mg/mg 2x faster than MMF + LDS alone: 169 days vs. 372 days in patients taking MMF + low-dose steroids alone (median)(HR: 2.0; 95% CI: 1.5 to 2.7).^4,5,b,d

Podocyte stability

LUPKYNIS addresses key aspects of LN pathophysiology through its unique dual mechanism of action. It both inhibits T-cell activation and promotes podocyte stability.^4,6 Supporting podocyte structure and function may be disease-modifying in LN.⁵

Prednisone reduction

Approximately 80% of patients treated with LUPKYNIS were tapered to, and maintained on, low doses of steroids (≤2.5 mg/day) through Year 3. ^3-5,b,e

By integrating these evidence-based recommendations and prescribing a treatment like LUPKYNIS to help support ACR Guideline goals, you can take meaningful steps toward improving long-term kidney outcomes.^2-5

Please see full Prescribing Information for LUPKYNIS or visit LUPKYNISpro.com to learn more.

^aPrimary endpoint for AURORA 1. Stringent criteria for complete renal response included: UPCR ≤0.5 mg/mg; eGFR ≥60 mL/min/1.73 m² or no confirmed decrease from baseline in eGFR > 20% or no treatment- or disease-related eGFR-associated event; sustained low-dose steroids; no administration of rescue medications.⁴

^bAURORA 1 was a 52-week, randomized, double-blind, placebo-controlled, phase 3 trial of 357 patients evaluating MMF + LDS with (N=179) or without (N=178) the addition of LUPKYNIS in adults with active LN.^4,5

^c81% more likely calculation: ([40.8 - 22.5 = 18.3]/22.5) x 100 = 81.3%.⁴

^dSecondary endpoint for AURORA 1.⁵

^eAURORA 2 was a double-blind, placebo-controlled, 24-month continuation study that enrolled 216 (84.7%) patients who completed 12 months of treatment in AURORA 1; 116 patients were enrolled in the LUPKYNIS arm, and 100 patients were enrolled in the active control arm.³

References: 1. Anders H-J, et al. Nat Rev Dis Primers. 2020;6(1):7. 2. Sammaritano LR, et al. Arthritis Rheumatol. 2025;77(9):1115-1135. 3. Saxena A, et al. Arthritis Rheumatol. 2024;76(1):59-67. 4. LUPKYNIS®. Prescribing information. Aurinia Pharma U.S., Inc.; 2025. 5. Rovin BH, et al. [Erratum in Lancet. 2021;397(10289):2048.] Lancet. 2021;397(10289):2070-2080. 6. Dall'Era M, et al. Lupus Sci Med. 2024;11(2):1-12.

ACR=American College of Rheumatology; CI=confidence interval; eGFR=estimated glomerular filtration rate; HR=hazard ratio; OR=odds ratio; UPCR=urine protein-to-creatinine ratio.

INDICATION

LUPKYNIS is indicated in combination with a background immunosuppressive therapy regimen for the treatment of adult patients with active lupus nephritis (LN).

Limitations of Use: Safety and efficacy of LUPKYNIS have not been established in combination with cyclophosphamide. Use of LUPKYNIS is not recommended in this situation.

IMPORTANT SAFETY INFORMATION

BOXED WARNING: MALIGNANCIES AND SERIOUS INFECTIONS

LUPKYNIS increases the risk of serious infections and malignancies that may result in hospitalization or death. See full Prescribing Information for complete BOXED WARNING.

CONTRAINDICATIONS

DO NOT use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin).
DO NOT use LUPKYNIS if a patient has a history of serious hypersensitivity reactions, including anaphylaxis, to LUPKYNIS or any of its components.

WARNINGS AND PRECAUTIONS

Nephrotoxicity may occur. Monitor eGFR and adjust dose as needed.
Hypertension is common. Monitor blood pressure. May require antihypertensive therapy; watch for possibility of drug interactions with some antihypertensives.
Neurotoxicity: Monitor for neurologic symptoms including risk of posterior reversible encephalopathy syndrome (PRES).
Hyperkalemia: Monitor potassium, especially with concomitant agents associated with hyperkalemia.
QT Prolongation: Monitor ECG and electrolytes in high-risk patients.
Hypersensitivity Reactions (Including Anaphylaxis and Angioedema): Monitor and discontinue if reaction occurs.
Pure Red Cell Aplasia: Monitor and consider discontinuation if diagnosed.
Immunizations: Avoid live vaccines.
Lymphomas and Other Cancers: Immunosuppressants increase the risk of lymphomas and other cancers, especially of the skin. Monitor for skin changes and advise sun protection and avoidance of artificial UV light.

ADVERSE REACTIONS

The most common adverse reactions (≥3% and ≥2% against placebo) include decreased GFR, hypertension, diarrhea, headache, anemia, cough, urinary tract infection, abdominal pain upper, dyspepsia, alopecia, renal impairment, abdominal pain, mouth ulceration, fatigue, tremor, acute kidney injury, and decreased appetite. Nausea and vomiting have been reported during post-approval use.

SPECIFIC POPULATIONS

Pregnancy: Inform female patients of the potential risk to a fetus and to avoid use of LUPKYNIS during pregnancy.

Please see full Prescribing Information, including BOXED WARNING, and Medication Guide for additional Important Safety Information about LUPKYNIS.