Eligibility

  • Fulfilment of the EULAR/ACR classification criteria of SLE.
  • 18 years of age or above.
  • Incident biopsy-proven proliferative or membranous LN, or combinations thereof (with UPCR ≥ 1 g/g), i.e.
    • 2003 ISN/RPS class III (A or A/C) ± V
    • 2003 ISN/RPS class IV (A or A/C) ± V
    • 2003 ISN/RPS class V
  • Consent to the possibility of a repeat kidney biopsy at month 12 from baseline.
  • Initiation of the following treatment regimens:
    • intravenous pulses of methylprednisolone (total dose of 500–2500 mg)
    • oral prednisone or equivalent 0.3–0.5 mg/kg/day with tapering
    • hydroxychloroquine unless contraindicated
    • angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)
    • either one of
      • mycophenolate mofetil (MMF) equivalent dose 2–3 g/day, or
      • IV cyclophosphamide (CYC) according to the Euro-Lupus regimen
        [Houssiau FA et al. Arthritis Rheum 2002], followed by azathioprine (AZA; 2 mg/kg/day) or mycophenolate mofetil (MMF) equivalent dose 1–2 g/day
    • add-on therapies (e.g. calcineurin inhibitors, biologics) to the above two regimens are optional.
  • Antiphospholipid syndrome nephropathy (APSN).
  • Pregnancy at baseline (pregnancy during follow-up will not lead to exclusion).
  • Anticoagulation and/or other medical contraindications to kidney biopsy, e.g. thrombocytopenia < 50,000/μL, uncontrolled hypertension or end-stage kidney disease (ESKD).
  • Anticipated non-adherence to therapy.
  • Medical conditions interfering with outcome evaluations.
  • Inability to read and/or sign the informed consent form.