Comparative analysis of lupus nephritis guidelines: ACR 2025, EULAR 2025, and KDIGO 2024

Lupus nephritis (LN) is a major driver of morbidity and kidney failure in systemic lupus erythematosus, and its management has grown substantially more complex with the emergence of targeted therapies. Between 2024 and 2025, the American College of Rheumatology, the European Alliance of Associations for Rheumatology, and Kidney Disease: Improving Global Outcomes each released updated recommendations grounded in a largely shared evidence base but differing in scope, clinical profiling, and operational emphasis. This review compares the three frameworks, highlighting key areas of convergence and divergence relevant to contemporary clinical practice. The main themes include the shift toward early combination regimens targeting complementary immune pathways, driven by the emergence of targeted therapies such as belimumab, voclosporin, and obinutuzumab; the incorporation of clinical profiling to guide therapy selection and monitoring; strategies aimed at rapid glucocorticoid minimization; and the growing recognition of renoprotective therapy as a central pillar of LN care within a chronic kidney disease management strategy.