Red Flags to Renal Rescue: Strengthening LN Care in Federal and FQHC Practice Environments

Lupus nephritis (LN) is one of the most consequential organ manifestations of systemic lupus erythematosus (SLE), occurring in approximately 40% to 60% of patients, most often within the first 5 years of diagnosis, and progressing to end-stage kidney disease in 10% to 20% of patients. LN is disproportionately concentrated in populations commonly cared for in federal, Veterans Affairs (VA), safety-net, and federally qualified health center (FQHC) practice environments, including Black, Hispanic, American Indian/Alaska Native, and Asian patients, as well as other patients with complex multimorbidity. Despite the availability of LN-specific U.S. Food and Drug Administration (FDA)-approved therapies, including belimumab, voclosporin, and obinutuzumab, as well as therapies approved for active extrarenal SLE manifestations, clinical practice continues to lag behind the evidence. The average time from SLE symptom onset to diagnosis is 6.29 years, and Black patients with SLE die approximately 13 years younger than their White counterparts; additionally, fewer than half of patients with active LN achieve a complete renal response at 1 year on conventional therapy. The 2024 American College of Rheumatology (ACR) Lupus Nephritis Guideline, the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guideline, and the 2025 European Alliance of Associations for Rheumatology (EULAR) recommendations for SLE with kidney involvement now converge on a practical care framework: routine surveillance for kidney involvement, early biopsy when LN is suspected, hydroxychloroquine (HCQ) at ≤5 mg/kg actual body weight when not contraindicated, glucocorticoid minimization, early use of combination immunosuppression, nephroprotective care, and treat-to-target monitoring using renal response criteria.

In this CME Outfitters monograph, expert faculty will discuss recognizing early clinical and laboratory indicators of LN; implementing equitable guideline-concordant care that includes effective screening, referral, and patient-centered communication—especially in underserved populations—to support timely diagnosis; and integrating emerging LN therapies and clinical trial evidence into personalized, steroid-sparing treatment decisions and sequencing.

At the conclusion of this activity, learners will be able to better:

• Identify early clinical and laboratory indicators of LN and apply guideline-recommended screening and referral practices to enable timely diagnosis
• Integrate emerging LN therapies and clinical trial evidence into personalized, steroid-sparing treatment selection and sequencing
• Develop strategies for equitable, guideline-concordant LN screening, referral, and patient-centered communication for high-risk and underserved populations (including Veterans and patients in safety-net and Federally Qualified Health Center [FQHC] settings)

Supported by an educational grant from Genentech, a member of the Roche Group.

Rheumatologists, nephrologists, primary care physicians (PCPs), OB/GYNs, nurse practitioners (NPs) physician associates (PAs), and pharmacists who care for patients with lupus in community, federal, and Veterans Affairs (VA) health services settings

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Lim reports the following financial relationships:

Advisory Board: AstraZeneca; GlaxoSmithKline; and Roche/Genentech

Research Support: AstraZeneca; Bristol-Myers Squibb; EMD Serono; and Novartis

The following individuals have no financial relationships to disclose:

Jeffrey Helfand, DO (Peer Reviewer)
Albert Eubanks, Jr., RN (Peer Reviewer)
Andrea Perseghin, EdD (Planning Committee)
Sharlinda Warner (Patient Planner)
Susan Perry (Planning Committee)
Felicia Oyedepo, MD (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

*All identified conflicts of interest have been mitigated.

Unlabeled Use Disclosure
Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CME Outfitters, LLC, the faculty, planners, and reviewers do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

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