Patient handout

Lupus nephritis

PRODUCTION

1. Your condition

This handout is for lupus nephritis. Your care team identified this based on: new proteinuria — upcr ≥0.5 g/g in known/suspected sle.

Other reasons your team may use this plan: active urinary sediment — dysmorphic rbc / rbc casts; rising creatinine / falling egfr in sle patient; rising anti-dsdna + falling c3/c4 with renal signs.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
hydroxychloroquine	≤5 mg/kg actual weight (typically 200–400 mg/d)	PO	daily	2024 KDIGO — HCQ for ALL LN unless contraindicated; renal response + flare + survival benefit; retina screen baseline + annual after 5 y
lisinopril	Titrate to max tolerated for BP <130/80 + proteinuria reduction	PO	daily	2024 KDIGO — RAAS blockade for all proteinuric LN; antiproteinuric + renoprotective; HOLD/avoid in pregnancy (fetotoxic) — substitute labetalol/nifedipine
losartan	Titrate to BP/proteinuria target	PO	daily	ARB alternative when ACEi-intolerant; same pregnancy contraindication
inactivated vaccination pre-immunosuppression	Pneumococcal, influenza, COVID, recombinant zoster, HBV per status	IM/SC	per schedule before ISD	KDIGO/EULAR — vaccinate before immunosuppression; LIVE vaccines contraindicated once immunosuppressed

Plan: Lupus nephritis — ISN/RPS class-driven (biopsy not serology decides; 2024 KDIGO LN)

3. When to call your provider

Contact your care team if any of the following happen:

Rapidly rising creatinine / RPGN then ED + urgent inpatient biopsy + pulse MP (KDIGO 2024)
Nephrotic + thrombosis (membranous + APS) then admit + anticoagulate (KDIGO 2024)
Severe uncontrolled HTN then admit (KDIGO 2024)
Concurrent NPSLE / alveolar hemorrhage / severe cytopenias then ED + ICU (EULAR 2023)
Pregnancy with active LN then MFM co-management urgently (KDIGO 2024)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Rapidly rising creatinine + active sediment ± crescents on biopsy (RPGN/AKI in LN)(life-threatening)
Nephrotic-range proteinuria + thrombosis (pure membranous class V + APS)(life-threatening)
Concurrent NPSLE / diffuse alveolar hemorrhage / severe cytopenias with active LN(life-threatening)
Pregnancy with active LN — distinguish renal flare from preeclampsia
Class IV proliferative LN not responding to adequate induction (no partial response by 3–6 mo / no complete by 12 mo)
Fever + renal signs + elevated CRP / positive cultures in immunosuppressed LN patient

5. Follow-up

Prolonged maintenance ≥3 yr (MMF/AZA + low-dose GC + HCQ); treat-to-target proteinuria <0.5–0.7 g/g; CV + infection risk modification; vaccinations; ESKD/transplant planning + post-transplant LN recurrence surveillance; pregnancy planning when stable ≥6 mo on compatible drugs

6. Sources

Guideline: 2024 KDIGO Lupus Nephritis Guideline + 2023/2024 EULAR/ERA-EDTA LN recommendations + ACR; AURORA voclosporin; BLISS-LN belimumab; Euro-Lupus