{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:17:34Z","timestamp":1792700254491,"version":"4.5.0"},"reference-count":74,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","award":["AN372\/29-1 and 35-1, 554613516"],"award-info":[{"award-number":["AN372\/29-1 and 35-1, 554613516"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015883","name":"Sociedad Espa\u00f1ola de Nefrolog\u00eda","doi-asserted-by":"crossref","award":["Beca de la Fundaci\u00f3n SENEFRO para rotaci\u00f3n de residentes de Nefrolog\u00eda en Centros extranjeros"],"award-info":[{"award-number":["Beca de la Fundaci\u00f3n SENEFRO para rotaci\u00f3n de residentes de Nefrolog\u00eda en Centros extranjeros"]}],"id":[{"id":"10.13039\/100015883","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    Lupus nephritis (LN) is seeing more and more enriching immunotherapies, but important unmet needs remain. Here, we discuss how to focus on histologic signs of immunologic activity triggering immunotherapy versus signs of irreversible kidney injury requiring care for CKD. In addition, the correct interpretation of residual proteinuria requires dissecting immunologic activity from glomerular hyperfiltration,\n                    <jats:italic toggle=\"yes\">e.g<\/jats:italic>\n                    ., by repeat biopsy. Despite modern triple immunotherapy, per-protocol biopsies still document irreversible injury to occur in the first year. Immediate inhibition of the complement system may address this unmet need and may even help to ultimately replace early glucocorticoid therapy. We advocate the concept of a clone-directed therapy to sufficiently suppress the autoreactive clones of memory B and T cells inside the lymphoid tissues as well as the long-lived plasma cells in the bone marrow that maintain activity of SLE and drive disease flares. Numerous B-cell and plasma cell\u2013targeting therapies are gradually becoming available, and their parenteral route of application may also avoid oral drug nonadherence. Replacing oral and toxic medications such as steroids, mycophenolate, and calcineurin inhibitors is now a goal for the next decade. Obtaining orphan disease designation for LN would accelerate progress and is supported by latest data on LN prevalence. With these conceptual and management improvements, LN, once \u201ccomplex\u201d and frequently fatal, may become easy-to-manage as other autoimmune diseases.\n                  <\/jats:p>","DOI":"10.2215\/cjn.0000000858","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T16:00:38Z","timestamp":1754928038000},"page":"1796-1806","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Lupus Nephritis"],"prefix":"10.2215","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8351-2307","authenticated-orcid":false,"given":"Matteo","family":"Abinti","sequence":"first","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9669-0071","authenticated-orcid":false,"given":"Marc","family":"Patricio-Liebana","sequence":"additional","affiliation":[{"name":"Nephrology Department, Vall d\u2019Hebron Hospital Campus, Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2434-2956","authenticated-orcid":false,"given":"Hans-Joachim","family":"Anders","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hospital of the Ludwig-Maximilians University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"issue":"4","key":"B1-20251219","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1002\/art.42375","article-title":"Incidence, prevalence, and 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