Biopsy is the best way to identify kidney disease early, says Sandra C. Raymond, the president and CEO of the Lupus Foundation of America in Washington D.C. "It is the quintessential diagnosis tool for lupus nephritis. They can tell whether it is lupus or not that is causing the symptoms."
The guidelines also state that people with lupus nephritis may benefit from "background treatment" with the anti-malarial drug hydroxychloroquine to prevent damage to the kidney and elsewhere in the body.
Blood pressure and cholesterol control is also key. "Blood pressure should never be higher than 130/80," Hahn says. Some blood pressure medications known as ACE inhibitors and ARBs may also protect the kidney.
Guidelines Discuss Treating Flares
There are also more options to treat active lupus nephritis today than ever before.
The new guidelines may help persuade insurers to cover the costs of some of the newer drugs.
There is trial and error involved in getting the disease under control. "If people aren't improving by six months, they should switch to another therapy," Hahn says. "If they are worsening at three months, they should switch to another treatment."
Pregnant women with lupus nephritis present a special challenge. Many of the available drugs can't be used during pregnancy.
"We don't know how rapidly you can taper off of or stop these treatments without risking a flare when a patient wants to become pregnant, either," Hahn says.
Still, LFA's Raymond adds: "Lupus nephritis care has come a long way in the past two or three decades. Today's medication can stop the disease from progressing."
And the new guidelines will pave the way for future advances, says David Pisetsky, MD, in an email. He is the chief of rheumatology at Duke University Medical Center in Durham, N.C.
"These guidelines are very important to the care of patients as well as research, including clinical trials of new agents and treatment approaches," he says. "They are a needed foundation for future work."