Lupus nephritis is kidney inflammation caused by lupus, affecting roughly half of people with systemic lupus erythematosus. Treatment pairs drugs that quiet the immune system with medications to protect kidney function. Many people respond well, but some progress to kidney failure requiring dialysis or transplant.
What's actually going on in research
Trials are testing new immune-suppressing drugs that may work faster or cause fewer side effects than current options. Voclosporin and belimumab are FDA-approved additions to standard treatment. Researchers are studying drugs that target specific immune pathways, including B cells, complement proteins, and interferon signaling, along with biomarkers that predict flares before damage occurs.
Targeted immune therapies
Drugs like anifrolumab (targeting interferon) and obexelimab (targeting B cells) aim to quiet lupus at specific molecular steps. Early results suggest they may spare people from high-dose steroids.
Complement inhibitors
The complement system amplifies kidney inflammation in lupus nephritis. Several trials are testing drugs that block complement proteins to reduce kidney damage.
Biomarker-guided treatment
Researchers are identifying blood and urine markers that signal a flare before kidney function drops. This could allow earlier treatment adjustments and prevent permanent damage.
What to know before you search
Eligibility typically depends on biopsy-confirmed lupus nephritis class, recent flare activity shown in urine protein or kidney function tests, and prior treatments used.
What types of trials are currently open
- Induction trials — Testing new combinations of drugs to quickly bring active lupus nephritis under control, often comparing against mycophenolate or cyclophosphamide.
- Maintenance trials — Testing long-term drugs to keep lupus nephritis quiet after initial treatment, aiming to prevent flares with fewer side effects.
- Biomarker studies — Tracking blood and urine markers to predict flares and guide when to intensify or reduce treatment.
- Combination trials — Adding new drugs like voclosporin or belimumab to standard treatment to improve response rates.
- Kidney biopsy studies — Following kidney tissue changes over time to understand how different treatments affect inflammation and scarring.
Recently added LUPUS Nephritis trials
Take a steroid medication at an optimized dose for lupus kidney disease
Childhood-onset systemic lupus erythematosus (cSLE) is a severe chronic autoimmune disease with a high burden of major-organ involvement. Lupus nephritis (LN) affects more than half of children with SLE, and proliferative LN-including class III, IV, III+V, and IV+V disease-is associated with acute kidney injury, progression to end-stage kidney disease, and poor long-term outcomes. Glucocorticoids remain a cornerstone of induction therapy for proliferative LN. However, the optimal initial dose in children is uncertain. Although recent adult SLE and LN guidelines increasingly recommend lower-dose glucocorticoid regimens with rapid tapering, pediatric guidelines still commonly recommend high initial prednisone doses of 1.5-2.0 mg/kg/day. Adult trials and comparative observational studies suggest that lower-dose glucocorticoid regimens may preserve efficacy while reducing treatment-related toxicity. Because cumulative glucocorticoid exposure in children may impair growth, development, psychosocial well-being, and medication adherence, this trial will compare low-dose versus high-dose initial glucocorticoid regimens for induction treatment of pediatric proliferative LN. The objective is to determine whether a lower-dose regimen is non-inferior in efficacy while reducing glucocorticoid-related adverse effects and improving quality of life.
The Efficacy of Empagliflozin on Kidney Functions in Lupus Nephritis Population
Systemic lupus erythematosis (SLE) is a chronic, most probably auto-immune multisystem disease marked by relapsing-remitting course and the formation of a range of autoantibodies. SLE patients present with serious renal (lupus nephritis (LN)), cardiopulmonary, or nervous manifestation. LN occurs in 40%-70% of SLE cases during the first 10 years of disease and is marked by the presence of proteinuria (hallmark). A novel class of medications had been extracted from phlorizin and indicated for the treatment of type 2 diabetes (T2D), referred to as Sodium glucose cotransporter 2 (SGLT-2) inhibitors. They act by decreasing glucose reabsorption in the proximal renal tubules (SGLT2). Previous studies proved that SGLT2 inhibitors resulted in decreased postprandial hyperglycemia, enhanced glycemic control, reduced body weight and blood pressure, and albuminuria in those with T2D. Large placebo-controlled trials such as Empagliflozin-Kidney (EMPA-Kidney) and Dapagliflozin in Patients with Chronic Kidney Disease (DAPA-CKD) trial demonstrated the efficacy of empagliflozin and dapagliflozin, respectively, in patients with chronic kidney disease (CKD) regardless the diabetic cause of CKD, compared to placebo. EMPA-Kidney with median 2.0 years of follow-up reported that empagliflozin (EMPA) significantly (P\<0.001) lowered (13.1%) the risk of progression of kidney disease and death from cardiovascular causes than placebo (16.9%). Together with, DAPA-CKD trial reported that the risk of a composite of a sustained decline in the estimated GFR of at least 50% was significantly (P\<0.001) lower in the DAPA group (9.2%) compared to placebo group (14.5%) over a median of 2.4 years of follow-up. However, such studies excluded lupus nephritis population from clinical trials. Consequently, an experimental study is conducted to test the hypothesis that SGLT2 inhibitor EMPA is superior to placebo in improving proteinuria and estimated glomerular filtration rate (eGFR) in a group of patients with established LN already receiving the usual standard care and treatment. The trial participants compatabile with the elgibility criteria will be randomly assigned to two groups. One group will take Empagliflozin 25 mg tablet each day along with the standard care therapy. The other group will take a matching placebo besides the usual standard care therapy during the clinical trial period. Study outcomes will be measured three times, one before starting the medical study, the second and third will be 6 and 12 weeks after starting the clinical study, respectively. After that, the statistical siginficance of values between both groups will be reported to test the credibilty of the hypothesis. The study is primarily designed to evaluate the reno-protective effect of EMPA on kidney function, in terms of urinary protein-creatinine ratio (uPCR)and eGFR. Empagliflozin efficacy testing in lupus nephritis population (EMPA-LN) is a prospective, randomized, triple-blinded, parallel-group, placebo controlled phase 4 trial recruiting 66 subjects. A 10% drop-out rate is anticipated based on the clinical opinion of the care provider. The study will be conducted in accordance with the declaration of Helsinki. An ethical approval will be provided from an ethics committee.
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