Abstract: SA-PO0783
Towards an Interdisciplinary Consensus Definition of "Refractory Lupus Nephritis": A Kickoff Survey
Session Information
- Glomerular Research: Design, Registries, Surveys, and Epidemiology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Anders, Hans J., Ludwig-Maximilians-Universitat Munchen, Munich, BY, Germany
- Lichtnekert, Julia, Ludwig-Maximilians-Universitat Munchen, Munich, BY, Germany
- Arora, Swati, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Grigorescu Vlass, Melissa, Ludwig-Maximilians-Universitat Munchen, Munich, BY, Germany
- Touma, Zahi, Toronto Western Hospital, Toronto, Ontario, Canada
Background
There is no consensus for the definition of “Refractory Lupus Nephritis (RLN)”, which leads to confusion and overuse of this term for patients not responding to immunotherapy as expected. However, definition criteria, time of assessment and how to exclude drug non-adherence remain under debate. The aim of this working group of LNTN is to approach a consensus definition to avoid over- or underuse of immunotherapy, to standardize patient management, and patient selection for clinical trials and research.
Methods
We initiated a Delphi consensus process to define consensus criteria for RLN. Initially we developed a Delphi questionnaire encompassing 25 questions on individual or composite criteria of treatment response, additional definition criteria including eGFR, urinary sediment, serum complement or autoantibodies, a preference for albuminuria or proteinuria, and timing of assessment depending on the type of medication used. We questioned the role of a re- or protocol biopsy in defining RLN and its timing as well as whether demographics, genetics, or comorbidities should be considered. We also inquired about evaluation of drug non-adherence prior to labeling as RLN. Results from the first Delphi round will be reported.
Results
To date, 256 LN specialists participated in the survey and 148 completed all questions. The 256 participants included 85 nephrologists, 60 rheumatologists, 20 internists and 108 did not specify. Regionally, 56 were from North America, 15 South America, 48 from Europe, 20 from Asia and 8 from Africa. The vast majority of participants had 6 or more years of clinical practice experience and reported an intermediate or high level of expertise in treating lupus nephritis. Responses are currently being analyzed and will be presented on site.
Conclusion
This kick-off survey is the starting point for the next rounds of the Delphi consensus process to ultimately arrive at an interdisciplinary consensus definition of RLN to support standardized patient management and clinical research, and to avoid unnecessary exposures to toxic and costly second or third line LN medications.