Algorithm for the Treatment of Membranous Lupus Nephritis

Sub-nephrotic-range proteinuria (<3.5g/d, normal serum albumin) and Preserved kidney function

1. Hydroxychloroquine

2. Kidney protective therapy

3. Immunosuppression to treat non-renal SLE

4. Consider immunosuppression to treat class V LN if proteinuria > 1 g/d

Close monitoring is recommended: Evaluate for worsening disease, Evaluate for transition to proliferative from of LN

Nephrotic proteinuria and/or worsening kidney function

1. Hydroxychloroquine

2. Kidney protective therapy

3. Immunosuppressive therapy to treat class V LN

 • MMF 2-3 g/d ± corticosteroid to treat extra-renal SLE

 • Calcineurin inhibitor therapy (cyclosporine or tacrolimus) ± corticosteroids

 • Cyclophosphamide ± corticosteroids

 • Multi-target therapy (MMF plus CNI)

 • Azathioprine ± corticosteroids



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