{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:14:38Z","timestamp":1788243278240,"version":"build-2803163510"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Translating the 2024 KDIGO (Kidney Disease: Improving Global Outcomes) lupus nephritis (LN) guideline update into routine care remains challenging. While clinical trial data support early multi-agent combination therapy for nephritis to optimize kidney protection, real-world implementation is constrained by disease heterogeneity, disparities in access to advanced therapeutics, and limited incorporation of cost-effectiveness considerations. In this perspective article, we propose a pragmatic framework to adapt KDIGO recommendations to diverse healthcare settings. First, we propose a stratification model integrating clinical response kinetics, serological markers, and histological chronicity. Second, we apply implementation science frameworks to identify diagnostic and therapeutic gaps. Finally, we outline a value-based approach to evaluate the use of biologics and small molecules in terms of short- and long-term clinical outcomes and economic sustainability. Together, these strategies provide a roadmap to improve the real-world applicability of modern LN management.<\/jats:p>","DOI":"10.1093\/ckj\/sfag267","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:40:11Z","timestamp":1786448411000},"source":"Crossref","is-referenced-by-count":0,"title":["Tailoring KDIGO guidelines for lupus nephritis to the real world: a stratified and cost-aware approach"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1266-9441","authenticated-orcid":false,"given":"Savino","family":"Sciascia","sequence":"first","affiliation":[{"name":"University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN Reconnet and RITA-ERN Member), University of Turin , Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-0210","authenticated-orcid":false,"given":"Brad","family":"Rovin","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Ohio State University , Columbus, OH, 43203 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Floege","sequence":"additional","affiliation":[{"name":"Division of Nephrology, RWTH Aachen University Hospital , Pauwelstr. 30, Aachen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026090101315139600_bib1","doi-asserted-by":"publisher","first-page":"825","DOI":"10.2215\/CJN.05780616","article-title":"Update on lupus nephritis","volume":"12","author":"Almaani","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101315139600_bib2","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.1002\/art.39594","article-title":"Risk of end-stage renal disease in patients with lupus nephritis, 1971-2015: a systematic review and Bayesian meta-analysis","volume":"68","author":"Tektonidou","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"2026090101315139600_bib3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2023.09.002","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. 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