National guidelines for the management of lupus nephritis in Saudi Arabia

Abstract

Context: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that can affect all organs and cause considerable morbidity and mortality. The estimated prevalence of SLE in the central region of Saudi Arabia is 19.28/100,000 individuals. Approximately half of those will eventually develop clinically significant renal disease. Therefore, screening for renal involvement is essential for early diagnosis and optimal disease management. Aims: This study aims to develop a pathway that can facilitate the early diagnosis and management of lupus glomerulonephritis in the Kingdom of Saudi Arabia. Methodology: The Saudi Society of Rheumatology in collaboration with the Saudi Society of Nephrology and Transplantation and under the supervision of the Saudi Commission for Health Specialties formed a committee involving rheumatologists, nephrologists, and a renal pathologist. Multiple workshops were conducted to adapt the 2019 Update of the Joint European League against Rheumatism and European Renal Association–European Dialysis and Transplant Association recommendations for the management of SLE, as well as The Kidney Disease: Improving Global Outcome 2020 using the ADAPTE process. Results: This document includes recommendations related to screening for renal involvement, renal pathology and classification, initial and subsequent therapy for lupus nephritis (LN), the treatment of refractory and relapsing LN, and the management of advanced renal disease. Recommendations concerning pregnancy and postpartum care are also included. Conclusion: We developed a guideline for the management of adults with LN based on recommendations developed elsewhere. This guideline was adapted to the local context of our health-care system.