EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update
Bibliographic record
Abstract
OBJECTIVES: The objective of this study was to update the 2019 European Alliance of Associations for Rheumatology (EULAR)/ European Renal Association/European Dialysis Transplantation Association (ERA-EDTA) recommendations for the management of systemic lupus erythematosus (SLE) with kidney involvement, taking into consideration emerging evidence and recent developments in the field. METHODS: We recruited an international Task Force of experts and followed the EULAR standard operating procedures. We performed systematic literature research (period January 2019 to March 2024), followed by the modified Delphi method, to form questions, elicit expert opinions, and reach consensus. The new evidence was examined, taking into consideration previous updates. RESULTS: The Task Force agreed on 4 overarching principles and 13 recommendations, which were also evaluated for their feasibility and impact on clinical care. These concern the use of kidney biopsy for diagnosis; targets of therapy and treatment milestones; immunomodulatory therapy with antimalarials, glucocorticoids, immunosuppressives (mycophenolate, cyclophosphamide, and calcineurin inhibitors), and biologics (belimumab, obinutuzumab, and rituximab); nonimmune therapy (kidney protection, vaccinations, cardiovascular, and bone protection); family planning; and management of kidney failure. Guidance on single-agent or early combination immune therapy, glucocorticoid tapering and withdrawal, duration of immune therapy, and treatment of refractory disease is provided. CONCLUSIONS: The updated EULAR recommendations provide evidence- and expert-based consensus on the management of SLE with kidney involvement, adjusted for severity, and taking into consideration long-term efficacy, safety, cost, and local availability of drugs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".