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. 2025 Oct 16:S0003-4967(25)04412-7.
doi: 10.1016/j.ard.2025.09.007. Online ahead of print.

EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update

Antonis Fanouriakis  1 , Myrto Kostopoulou  2 , Hans-Joachim Anders  3 , Jeanette Andersen  4 , Martin Aringer  5 , Michael W Beresford  6 , Andrea Doria  7 , Eleni Frangou  8 , Richard Furie  9 , Dafna D Gladman  10 , Frederic Houssiau  11 , Alexandre Karras  12 , Marios Kouloumas  13 , Anastasia-Vasiliki Madenidou  14 , Ana Malvar  15 , Smaragdi Marinaki  16 , Chi Chiu Mok  17 , Gabriella Moroni  18 , Ioannis Parodis  19 , Simona Rednic  20 , Cristiana Sieiro Santos  21 , Carlo Alberto Scire  22 , Josef S Smolen  23 , Farah Tamirou  11 , Yoshiya Tanaka  24 , Y K Onno Teng  25 , Elisabet Welin  26 , George Bertsias  27 , Dimitrios T Boumpas  28
Affiliations

EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update

Antonis Fanouriakis et al. Ann Rheum Dis. .

Abstract

Objectives: The objective of this study was to update the 2019 European Alliance of Associations for Rheumatology (EULAR)/ European Renal Association/European Dialysis Transplantation Association (ERA-EDTA) recommendations for the management of systemic lupus erythematosus (SLE) with kidney involvement, taking into consideration emerging evidence and recent developments in the field.

Methods: We recruited an international Task Force of experts and followed the EULAR standard operating procedures. We performed systematic literature research (period January 2019 to March 2024), followed by the modified Delphi method, to form questions, elicit expert opinions, and reach consensus. The new evidence was examined, taking into consideration previous updates.

Results: The Task Force agreed on 4 overarching principles and 13 recommendations, which were also evaluated for their feasibility and impact on clinical care. These concern the use of kidney biopsy for diagnosis; targets of therapy and treatment milestones; immunomodulatory therapy with antimalarials, glucocorticoids, immunosuppressives (mycophenolate, cyclophosphamide, and calcineurin inhibitors), and biologics (belimumab, obinutuzumab, and rituximab); nonimmune therapy (kidney protection, vaccinations, cardiovascular, and bone protection); family planning; and management of kidney failure. Guidance on single-agent or early combination immune therapy, glucocorticoid tapering and withdrawal, duration of immune therapy, and treatment of refractory disease is provided.

Conclusions: The updated EULAR recommendations provide evidence- and expert-based consensus on the management of SLE with kidney involvement, adjusted for severity, and taking into consideration long-term efficacy, safety, cost, and local availability of drugs.

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Conflict of interest statement

Competing interests AF reports lecture or consultancy fees from AstraZeneca, GSK, Boehringer Ingelheim, Genesis Pharma, Pfizer, AbbVie, and Eli Lilly. MK reports honoraria and/or consulting fees from GSK, participation in advisory boards from GSK, AstraZeneca, and Amgen. HJA reports lecture or consultancy fees from AstraZeneca, GSK, Novartis, Boehringer Ingelheim, Roche, and Otsuka. JA reports no direct conflict of interest, but LUPUS EUROPE is funded by grants or donations from Pharmaceutical Companies (Amgen/Horizon, AstraZeneca, Biogen, BMS, Galapagos, GSK, Viatris, Johnson & Johnson, Merck, Novartis, Otsuka, Roche, and UCB); none of which exceeds 25% of total funds collected, and none having a say on the content of studies or work by LUPUS EUROPE. MA reports advisory boards and/or lectures for AstraZeneca, GSK, Otsuka, and Roche. RF reports consulting fees from Genentech, GSK, Aurinia, Alexion, AstraZeneca, BMS, Novartis, Kyverna, and Boehringer Ingelheim. FH reports research grants from GSK and Roche and consulting/advisory fees from Neovacs, GSK, AstraZeneca, Eli Lilly, Idorsia, Otsuka, Biogen, and Galapagos. AK reports consultant fees from GSK, Vifor, Novartis, Otsuka, and Roche and honoraria from Pfizer, AstraZeneca, GSK, Novartis, Vifor, Otsuka, and Boehringer Ingelheim. AM reports advisory and speaker fees from GSK, Pfizer, Kezar, Roche, BMS, Novartis, and Biogen. AVM is funded by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC) (NIHR203308) (the views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care) and reports grant support from UCB and Janssen. GM reports speaker fees from GSK, Otsuka, and Vifor. IP reports research funding and/or honoraria from Amgen, AstraZeneca, Aurinia, BMS, Elli Lilly, Gilead, GSK, Janssen, Novartis, Otsuka, and Roche. YT reports speaking fees and/or honoraria from Chugai, UCB, AbbVie, AstraZeneca, Eli Lilly, Behringer-Ingelheim, GSK, Eisai, IQVIA, Daiichi-Sankyo, Otsuka, Taisho, Gilead, and BMS. GB has received honorary fees from GSK, AbbVie, AstraZeneca, UCB, Lilly, Otsuka, and Novartis and grants from MSD, AstraZeneca, and GSK. DTB reports unrestricted investigational grants from GSK and honoraria/consulting fees from GSK, AstraZeneca, AbbVie, Aenorasis, and Pfizer. The remaining authors declare no conflicts of interest.

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