Background: Lupus nephritis (LN) is a common complication in many patients with
systemic lupus erythematosus, although renal-limited lupus nephritis has been reported as well.
Early diagnosis of lupus nephritis is critical as early detection and effective treatment can improve
renal outcomes in such patients.
Objective: The treatment of lupus nephritis is largely determined based on the histological class
present on the renal biopsy specimen. In most cases, Class I and II of lupus nephritis do not require
any specific treatment, but class III and IV lupus nephritis require immunosuppressive therapy.
Treatment of Class V and VI remains controversial. In 2012, six guidelines were introduced for the
management of lupus nephritis. These guidelines offer comprehensive treatment plans for each
class of Lupus nephritis but differ from each other in many aspects. The purpose of this article is to
review the current literature of the available pharmacological treatments used in the six classes of
lupus nephritis as well as resistant lupus nephritis, strategies to address the problems of inadequate
therapeutic response, medication related side effects, relapses of lupus nephritis, and some future
Methods: We reviewed the available literature and treatment guidelines on lupus nephritis in detail
to present a comprehensive review of the available treatment options for different classes of lupus
Conclusion: Lupus nephritis which does not respond to initial treatment is associated with worse
renal outcomes. Several therapeutic approaches are available for the induction and maintenance
immunosuppression of the different classes of LN. Management of LN should be individualized for
each patient based on their risk-benefit profile.