Lupus nephritis is a common complication of systemic lupus erythematosus (SLE) and a determinant of overall morbidity and mortality, as lupus nephritis-related chronic kidney disease (CKD) drives cardiovascular disease and secondary immunodeficiency. Two lines of action are required to prevent the progression of lupus nephritis-related CKD: suppression of autoimmune SLE activity, which is a risk factor for immunopathology-related irreversible kidney injury, and management of non-immune risk factors that contribute to CKD progression. As each episode or relapse of active lupus nephritis implicates CKD progression, preventing flares of lupus nephritis is a key treatment target. Non-immune risk factors of CKD mostly include causes of nephron hyperfiltration, such as obesity, hypertension, sodium- or protein-rich diets and type 2 diabetes mellitus, as well as pregnancy. Nephrotoxic agents and smoking also drive kidney cell loss. Intrinsic risk factors for CKD progression include poor nephron endowment because of prematurity at birth, nephropathic genetic variants, ageing, male sex and previous or concomitant kidney diseases. Care for lupus nephritis involves the control of all modifiable risk factors of CKD progression. In addition, remnant nephron overload can be reduced using early dual therapy with inhibitors of the renin–angiotensin system and sodium–glucose transporter-2, whereas further renoprotective drug interventions are underway. As patients with lupus nephritis are at risk of CKD progression, they would all benefit from interdisciplinary care to minimize the risk of kidney failure, cardiovascular disease and infections.

狼疮性肾炎是系统性红斑狼疮 （SLE） 的常见并发症，也是总体发病率和死亡率的决定因素，因为狼疮性肾炎相关的慢性肾脏病 （CKD） 会导致心血管疾病和继发性免疫缺陷。需要采取两种行动来预防狼疮性肾炎相关 CKD 的进展：抑制自身免疫性 SLE 活性，这是免疫病理学相关不可逆性肾损伤的危险因素，以及管理导致 CKD 进展的非免疫危险因素。由于活动性狼疮性肾炎的每次发作或复发都涉及 CKD 进展，因此预防狼疮性肾炎发作是一个关键的治疗目标。CKD 的非免疫危险因素主要包括肾单位高滤过的原因，例如肥胖、高血压、富含钠或蛋白质的饮食和 2 型糖尿病，以及怀孕。肾毒性物质和吸烟也会导致肾细胞丢失。CKD 进展的内在风险因素包括出生早产导致的肾单位禀赋不良、肾病遗传变异、衰老、男性和既往或伴随的肾脏疾病。狼疮性肾炎的护理涉及控制 CKD 进展的所有可改变的危险因素。此外，使用肾素-血管紧张素系统和钠-葡萄糖转运蛋白-2 抑制剂的早期双重治疗可以减少残余肾单位超负荷，而进一步的肾脏保护药物干预正在进行中。由于狼疮性肾炎患者有 CKD 进展的风险，他们都将受益于跨学科护理，以最大限度地降低肾衰竭、心血管疾病和感染的风险。