Lupus nephritis stage IV can not be completely cured by plasma exchange, but it can alleviate the condition to a certain extent and slow down the development process of the disease. Lupus nephritis stage IV usually refers to diffuse proliferative lupus nephritis. Light microscopy shows that more than 50% of the glomeruli are involved, with extensive cellular proliferation and cellular infiltration, and extensive and severe nuclear fragmentation and crumpling. The basement membranes of glomerular capillaries are thickened and stiff, showing wire-loop changes, and immunofluorescence shows that large particles of immunoglobulin and complement are widely deposited in the peritubular area and capillaries. Plasma exchange can remove circulating immune complexes, anti-double-stranded DNA antibodies, antinuclear antibodies, anticardiolipin antibodies, etc. in patients with lupus nephritis, which can effectively alleviate the condition and achieve the therapeutic purpose. The indications for its application mainly include progressive renal and extra-renal organ involvement, as well as active lupus requiring high-dose hormone therapy. Since lupus nephritis is an autoimmune disease, it can only be controlled and slowed down, but not completely cured. Therefore, plasma exchange for lupus nephritis stage IV patients can only control the condition or improve the symptoms, but not completely cured. It is suggested that patients with lupus nephritis should consult a doctor in time and follow the doctor’s instructions to take active and standardized treatment.