[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-441032-105":59,"doc-detail-441032-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","refractory-lupus-nephritis-current-understanding-and-emerging-treatment-strategies-review","Refractory lupus nephritis: current Understanding and emerging treatment strategies - review","","Systemic Lupus Erythematosus (SLE) is an autoimmune disease driven by multifaceted immune dysregulation that leads to irreversible tissue and organ damage. Lupus nephritis (LN) is the most common and life-threatening organ involvement. Standard-of-care regimens have improved outcomes, yet refractory LN still faces major unmet needs, including no consensus definition, low remission and kidney survival, and poor prognosis. The review summarizes current knowledge and emerging strategies for refractory LN, emphasizing definition, clinical/prognostic features, and future treatment directions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/refractory-lupus-nephritis-current-understanding-and-emerging-treatment-strategies-review/441032/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/refractory-lupus-nephritis-current-understanding-and-emerging-treatment-strategies-review/441032.png","ImageObject",300,407,{"name":92,"@type":93},"Liam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the core clinical problem addressed for refractory lupus nephritis?","Question",{"text":112,"@type":113},"Refractory lupus nephritis remains a major challenge due to limited remission, reduced kidney survival, and persistent or recurrent disease activity despite standard-of-care treatment.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why is early identification of refractory LN difficult?",{"text":117,"@type":113},"There is currently no consensus definition for refractory LN, making recognition and prompt, consistent management challenging.",{"name":119,"@type":110,"acceptedAnswer":120},"What does standard-of-care treatment generally aim to achieve in lupus nephritis?",{"text":121,"@type":113},"Key goals include reducing urinary protein, protecting kidney function, and preventing or delaying deterioration, often assessed by partial or complete remission criteria.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},441032,1790778180,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Clinical and Experimental Medicine (2026) 26:78  \n[https://doi.org/10.1007/s10238-025-02014-1](https://doi.org/10.1007/s10238-025-02014-1)  \nREVIEW  \nRefractory lupus nephritis: current Understanding and emerging treatment strategies  \nTingting Ding1 · Yong Fan1 · Xiaohui Zhang1 · Zhuoli Zhang1  \nReceived: 12 November 2025 / Accepted: 15 December 2025 © The Author(s) 2025  \nAbstract  \nSystemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multifaceted immune dysregulation, which ultimately trigger irreversible damage of tissue and organ. Lupus nephritis (LN) is the most common and lifethreatening organ involvement of SLE. Although the prognosis of LN has been dramatically improved with the application of standard-of-care (SoC) regimens, there is an enormous unmet need regarding the global management of refractory LN. Currently, there is no consensus on definition for refractory LN, making early identification and prompt management greatly challengeable. Meanwhile, low remission rate and kidney survival rate, as well as poor prognosis has been longstanding clinical dilemmas for refractory LN. Fortunately, novel treatment options beyond SoC are constantly expanding. To change existing treatment paradigm and pave the way for precise treatment of refractory LN, we summarize current understanding and future considerations of refractory SLE, primarily focusing on the definition, clinical and prognostic characteristics, and emerging treatment strategies.  \nKeywords Lupus nephritis · Refractory · Diagnosis · Treatment · Management  \nIntroduction  \nSystemic lupus erythematosus (SLE) is a highly heterogeneous autoimmune disease, with various clinical manifestations and different combinations of autoantibodies. As oneof the most common manifestations, lupus nephritis (LN) affects nearly 40% of SLE patients [1,2], mainly characterized by proteinuria and sometimes active urinary sediment. Nephritic syndrome or progressive renal insufficiency can occur in severe cases. The diagnosis of LN requires a combination of clinical, laboratory examinations and renal  \n􀀍 Zhuoli Zhang [zhuoli.zhang@126.com](zhuoli.zhang@126.com)  \nTingting Ding  \n[tt_dinger@163.com](tt_dinger@163.com)  \nYong Fan  \n[fanyong59@sina.com](fanyong59@sina.com)  \nXiaohui Zhang  \n[beiyizhangxiaohui@163.com](beiyizhangxiaohui@163.com)  \n1 Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China  \npathologies. LN usually develops within 5 years of the diagnosis ofSLE, and 4.3%−10.1% LN patients can progression to end-stage kidney disease (ESKD) [3] .  \nOver the last few decades, the pathogenesis of LN has been widely studied. Generally, immunogenic endogenous chromatin has critically triggered the aberrant lymphocyte activation and autoantibodies overproduction in SLE. The deposition of circulating and/or in situ immune complexes and autoantibodies in glomerular or peri-glomerular regions of the kidney leads to kidney damage [4–6] . The complex crosstalk between immune cells and non-immune resident kidney cells remains elusive. Proteomics and RNA sequencing have led to meaningful improvement in understanding the pathogenesis of LN, and meanwhile accelerated various treatment targets to in clinical trials [7–11]. Accordingly, the treatment goals and approaches for LN are gradually clear. The treatment of lupus nephritis includes induction therapy for LN remission and maintenance therapy. High doseglucocorticoid combined with either cyclophosphamide (CYC) or mycophenolate mofetil (MMF) is recommended as the standard-of-care (SoC) regimens by major international consensuses, including KDIGO (kidney disease: Improving Global Outcomes), American College of Rheumatology (ACR), Asia Pacific League of Associations for  \n1 3  \nRheumatology (APLAR), and the European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA)[","cbCaiiiQnHQSZEGH","https://ap.wps.com/l/cbCaiiiQnHQSZEGH","pdf",1288391,13,"English","# Introduction\n# Current Understanding on Refractory LN\n## Current definitions and dilemmas in refractory LN\n## Diagnosis and clinical/prognostic characteristics\n# Emerging Treatment Strategies\n## Options beyond standard-of-care\n## Treatment goals and management approaches","[{\"question\":\"What is the core clinical problem addressed for refractory lupus nephritis?\",\"answer\":\"Refractory lupus nephritis remains a major challenge due to limited remission, reduced kidney survival, and persistent or recurrent disease activity despite standard-of-care treatment.\"},{\"question\":\"Why is early identification of refractory LN difficult?\",\"answer\":\"There is currently no consensus definition for refractory LN, making recognition and prompt, consistent management challenging.\"},{\"question\":\"What does standard-of-care treatment generally aim to achieve in lupus nephritis?\",\"answer\":\"Key goals include reducing urinary protein, protecting kidney function, and preventing or delaying deterioration, often assessed by partial or complete remission criteria.\"}]","Refractory lupus nephritis: current Understanding and emerging treatment strategies - review | PDF",1790694360,33]