Lupus nephritis: 17 quality indicators from the 2025 EULAR recommendations, and adherence linked to less damage

Design

Modified RAND/UCLA consensus plus single-centre cohort validation

Population

23 experts; 130 patients with lupus nephritis

Primary outcome

Adherence to quality indicators and association with damage accrual

Effect

High adherence: damage accrual OR 0.29 (95% CI 0.13 to 0.62)

A panel of 23 experts used a formal appropriateness method to turn the 2025 EULAR recommendations for lupus nephritis into 17 quality indicators across four domains: diagnosis, treatment, monitoring and pregnancy. The study was published in July.

The indicators were then applied to 130 patients in one tertiary centre. Adherence was high for kidney biopsy, hydroxychloroquine, maintenance immunosuppression, switching therapy in persistent or relapsing disease, renin-angiotensin blockade, remission before transplantation and pregnancy care. It was low for combination immunosuppression as initial treatment (10.7%), largely because most patients started treatment before the recommendations were published. Patients whose care met at least 80% of indicators had lower odds of damage accrual (OR 0.29, 95% CI 0.13 to 0.62); fewer renal flares did not reach significance.

The outcome link is observational in one centre, and patients who receive guideline-concordant care may differ in other ways.

The indicators give lupus clinics a ready-made audit. Many Indian centres manage large lupus nephritis caseloads, and a short checklist against current recommendations is a practical way to find gaps.

• Audit lupus nephritis care against the 17 EULAR-based indicators.
• Confirm every patient with lupus nephritis is on hydroxychloroquine unless contraindicated.
• Use renin-angiotensin blockade for proteinuria where appropriate.
• Review whether combination initial immunosuppression is being considered in line with the 2025 recommendations.
• Plan pregnancy with disease quiescence and medication review.

Why it matters

Recommendations only help patients if they are followed, and this provides a way to measure that.

Don't overread it

The link between adherence and less damage comes from one observational cohort and needs validation elsewhere.

The statistics, in plain English

An odds ratio of 0.29 means the odds of new organ damage were about 70% lower with high adherence. The interval is wide (0.13 to 0.62) because the cohort is small, and the association may partly reflect differences between patients.

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