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LN Maintenance Minimum 36 Months KDIGO — ESENeph MCQ

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ModerateGlomerulonephritisLN Maintenance Minimum 36 Months KDIGOESENeph

A 30-year-old woman with SLE and class IV lupus nephritis achieves complete renal response after 6 months of MMF induction. She is transitioned to MMF maintenance 1g BD with hydroxychloroquine and low-dose prednisolone. According to KDIGO 2024, what is the recommended minimum duration of maintenance immunosuppression after achieving complete response?

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Correct answer: A — At least 36 months (3 years)

KDIGO 2024 LN guidelines recommend a minimum of 36 months (3 years) of maintenance immunosuppression after achieving complete renal response in proliferative lupus nephritis. This extended duration reflects the high relapse rate with earlier withdrawal. Immunosuppression tapering should be gradual — typically reducing MMF dose stepwise while monitoring proteinuria, serology (anti-dsDNA, complement), and eGFR. Hydroxychloroquine should be continued long-term as it reduces flare risk independently. The exact duration beyond 3 years is individualised based on relapse risk factors, serological activity, and patient preference.

Reference: KDIGO 2024 – Lupus Nephritis Guideline; Moroni et al 2017 – LN Maintenance Duration