In lupus nephritis, what is the standard induction therapy and maintenance therapy?

• A. Induction with high-dose corticosteroids plus mycophenolate mofetil or cyclophosphamide; maintenance with mycophenolate mofetil or azathioprine
• B. Induction with NSAIDs; maintenance with prednisone
• C. Induction with plasmapheresis; maintenance with cyclophosphamide
• D. Induction with rituximab only; maintenance with azathioprine

Answer: (A)

Rapid suppression of immune-mediated kidney inflammation is the goal, followed by long-term maintenance to prevent relapse. In lupus nephritis, the induction phase combines high-dose corticosteroids with an immunosuppressant to quickly control disease activity. The most effective and commonly used options are mycophenolate mofetil or cyclophosphamide as the companion immunosuppressant. This pairing helps reduce proteinuria, preserve renal function, and bring about remission more reliably than steroids alone.

Once remission is achieved, maintenance therapy uses a less intensive immunosuppressant to keep the disease under control and prevent flare-ups. Mycophenolate mofetil or azathioprine are typical choices for maintenance, often with a gradual taper of steroids. Other regimens, such as relying on NSAIDs alone, plasmapheresis, or rituximab monotherapy, do not provide the same durable control as the standard induction-plus-maintenance approach described.