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.