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Lupus Nephritis CNI Selection — ESENeph MCQ

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ModerateGlomerulonephritisLupus Nephritis CNI SelectionESENeph

A 32-year-old woman with Class III/IV lupus nephritis is started on MPAA plus Glucocorticoids. Her eGFR is 65 mL/min/1.73m2. She has nephrotic-range proteinuria. According to KDIGO 2024, when might a CNI-containing regimen be preferred?

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Correct answer: D — When there is preserved kidney function and nephrotic-range proteinuria likely from podocyte injury

KDIGO 2024 LN guideline practice point 10.2.3.1.4 states that initial therapy including a CNI (Voclosporin, Tacrolimus, or Ciclosporin) may be preferred in patients with relatively preserved kidney function and nephrotic-range proteinuria likely due to extensive podocyte injury. CNIs improve podocyte structure. Caution is needed when eGFR is ≤45 mL/min/1.73m2 due to CNI nephrotoxicity risk.

Reference: KDIGO 2024 – Lupus Nephritis Guideline