{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:44:53Z","timestamp":1792413893520,"version":"4.4.0"},"reference-count":75,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019120","name":"Otsuka","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019120","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Lupus nephritis is a major cause of morbidity and long-term kidney damage in patients with systemic lupus erythematosus. Despite therapeutic advances, complete remission rates remain modest, and progress to kidney failure still occurs in a substantial proportion of patients. Contemporary management has shifted toward early initiation of \u2018triple therapy\u2019, yet patients continue to suffer from the adverse effects of prolonged glucocorticoid exposure. Challenges persist, including treatment duration, safe tapering, and the high rates of flare following immunosuppression withdrawal, underscoring the potential role of repeat kidney biopsy in guiding decisions. Poor adherence is very common and a significant impediment in daily practice and often leads to the incorrect classification of patients as having \u2018refractory disease\u2019. Furthermore, conventional biomarkers are not ideal for flare prediction. Emerging therapies offer promising efficacy but remain inaccessible for many patients due to high costs and different reimbursement policies. Comprehensive management further requires attention to pregnancy planning, infection prophylaxis, care of chronic kidney disease, and long-term complications such as malignancy and osteoporosis. The goal should be to preserve kidney function, minimize cumulative toxicity, and restore quality of life to all patients, regardless of geography or economic status. This article provides a perspective of the Immunonephrology Working Group of the European Renal Association and discusses the key unmet needs in the management of lupus nephritis.<\/jats:p>","DOI":"10.1093\/ndt\/gfag220","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:10:07Z","timestamp":1790334607000},"source":"Crossref","is-referenced-by-count":0,"title":["Unmet needs in the management of adult patients with lupus nephritis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4341-5252","authenticated-orcid":false,"given":"Seyda Gul","family":"Ozcan","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa , Istanbul ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Bruchfeld","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Renal Medicine, CLINTEC Karolinska Institutet, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5830-9663","authenticated-orcid":false,"given":"Fernando","family":"Caravaca-Fontan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Instituto de Investigaci\u00f3n Hospital 12 de Octubre , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9377-4133","authenticated-orcid":false,"given":"Sarah M","family":"Moran","sequence":"additional","affiliation":[{"name":"Cork University Hospital, University College Cork , Cork ,","place":["Republic of Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-494X","authenticated-orcid":false,"given":"Stefanie","family":"Steiger","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine IV, Hospital of the Ludwig Maximilians University of Munich , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2291-1692","authenticated-orcid":false,"given":"Kate I","family":"Stevens","sequence":"additional","affiliation":[{"name":"Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9920-2195","authenticated-orcid":false,"given":"Y K Onno","family":"Teng","sequence":"additional","affiliation":[{"name":"Center of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine\u2014Nephrology Section, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Frangou","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Limassol General Hospital, State Health Service Organization , Limassol ,","place":["Cyprus"]},{"name":"University of Nicosia Medical School , Nicosia ,","place":["Cyprus"]},{"name":"Medical School, National and Kapodistrian University of Athens , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kronbichler","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck , Innsbruck ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7582-8476","authenticated-orcid":false,"given":"Luis F","family":"Quintana","sequence":"additional","affiliation":[{"name":"National Reference Centre on Complex Glomerular Disease (CSUR), Nephrology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0362-8154","authenticated-orcid":false,"given":"Safak","family":"Mirioglu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul ,","place":["Turkey"]},{"name":"Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University , Istanbul 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