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LN significantly increases the risk of mortality and progression to end-stage kidney disease. Glucocorticoids have been central to LN treatment for decades due to their anti-inflammatory properties, but optimal dosing strategies remain uncertain. The review discusses the historical evolution of glucocorticoid use, highlighting the shift from high-dose regimens to combined approaches with immunosuppressants and lower glucocorticoid doses to minimize adverse effects. Mechanistically, glucocorticoids exert effects through genomic and non-genomic pathways, modulating immune responses and metabolism. Long-term use is associated with risks such as infection, osteoporosis, hyperglycemia and cardiovascular disease. The review examines different dosing strategies, including intravenous pulse therapy and oral regimens, and presents evidence of their efficacy and safety. It also explores alternative approaches, such as low-dose and glucocorticoid-free regimens, which show promise but require further study. The review concludes by emphasizing the need for future research to optimize glucocorticoid regimens, refine tapering protocols and identify safer therapeutic combinations, as glucocorticoids remain a cornerstone in LN management despite their challenges.<\/jats:p>","DOI":"10.1093\/ndt\/gfae294","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T01:52:25Z","timestamp":1734745945000},"page":"1284-1293","source":"Crossref","is-referenced-by-count":9,"title":["Optimal glucocorticoid therapy in lupus nephritis"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6077-8899","authenticated-orcid":false,"given":"Gabriel","family":"Figueroa-Parra","sequence":"first","affiliation":[{"name":"University Hospital \u201cDr Jos\u00e9 Eleuterio Gonz\u00e1lez\u201d, Universidad Aut\u00f3noma de Nuevo Le\u00f3n Rheumatology Service, Department of Internal Medicine, , Monterrey ,","place":["M\u00e9xico"]},{"name":"Mayo Clinic Division of Rheumatology, , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Bautista-Vargas","sequence":"additional","affiliation":[{"name":"Mayo Clinic Division of Rheumatology, , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1204-1290","authenticated-orcid":false,"given":"Erika","family":"Navarro-Mendoza","sequence":"additional","affiliation":[{"name":"Mayo Clinic Division of Rheumatology, , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al\u00ed","family":"Duarte-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Mayo Clinic Division of Rheumatology, , Rochester, MN 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