2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (eular/era–edta) recommendations for the management of lupus nephritis

Recommendation/statement
Loe/GoR
LoA, mean (sd)
1. Investigation of the patient with suspected LN
1.1 Kidney biopsy should be considered when there is evidence of kidney involvement, especially in the presence of persistent proteinuria 
≥0.5 g/24 hours (or UPCR ≥500 mg/g in morning first void urine),
2b/b
9.84
(
0.54
)
and/or an unexplained decrease in GFR.
2b/C
1.2 Kidney biopsy remains indispensable and its diagnostic and prognostic value cannot be substituted by other clinical or laboratory 
variables.
2b/b
9.96
(
0.20
)
2. Pathological assessment of kidney biopsy
2.1 The use of the International Society of Nephrology/Renal Pathology SocietyISN/RPS 2003 classification system is recommended,
2a/b
9.56
(
0.94
)
with additional assessment of activity and chronicity indices,
1b/A
as well as of thrombotic and vascular lesions associated with aPL/syndrome.
2b/C
3. Indications for immunosuppressive treatment
3.1 Immunosuppressive agents, administered in combination with glucocorticoids, are recommended in class III
A
or III
A/C
(±V) and IV
A
or 
IV
A/C
(±V) nephritis.