This year, World Kidney Disease Day falls on the same day as International Women’s Day. Therefore, the slogan of Kidney Disease Day is “Focus on Kidney Disease, Care for Women’s Health”. On the whole, kidney disease favors men, but lupus nephritis favors women. This is because women are more likely to develop SLE, and the disease is also likely to be complicated by lupus nephritis. Unfortunately, I have noticed that many patients with lupus are not receiving standardized treatment. Figure 1 The treatment of lupus erythematosus needs to be standardized urgently! 1.No use of hydroxychloroquine Except for a very few patients (with serosanguinosis, etc.) who cannot be treated with hydroxychloroquine for lupus erythematosus, the vast majority of lupus erythematosus patients should be treated with hydroxychloroquine. However, many doctors are not standardized in their treatment and do not use Hydroxychloroquine as the basic drug for lupus treatment, especially doctors from nephrology department tend to miss Hydroxychloroquine. As the basis of lupus treatment, lupus nephritis should also be on hydroxychloroquine. Figure 2 The basic drug for lupus nephritis is also hydroxychloroquine. 2. Blindly relying on hormone therapy for lupus When treating moderate-to-severe lupus erythematosus, hormones, immunosuppressants, etc. are needed. Many doctors do not have a good understanding of “immunosuppressants”. Comparing “hormones” and “immunosuppressants”, hormones have worse efficacy and more side effects! The National Institutes of Health (NIH) of the United States of America initiated a study on the treatment of lupus nephritis in 1969, which spanned more than 17 years. Patients with lupus nephritis who had a “quantitative urine protein ≥ 1 g/day” were given the following choices: (1) hormone therapy alone; (2) hormone + azathioprine therapy; (3) hormone + cyclophosphamide therapy. The final comparative results were: (1) over 50% of the patients treated with hormones alone had uremia after 10 years, and 80% had uremia after 15 years; (2) in contrast, 40% of the patients treated with “hormones + azathioprine” had uremia after 15 years; and (3) only 10% of the patients treated with “hormones + cyclophosphamide” had uremia. More and more clinical trials are confirming that the therapeutic value of hormones is far less than that of immunosuppressants in moderate-to-severe lupus. Considering the side effects of combining the two, the use of hormones should be minimized, not the other way around. Figure 3 Moderate-to-severe lupus relies on immunosuppressants rather than hormones! Poor predictability of adolescent lupus treatment In adolescent patients with SLE, the tendency of lupus to become more severe needs to be anticipated! Adolescents may have a mild onset of disease, but the cumulative damage of lupus can be quite long, so lupus disease activity should be minimized. On the other hand, during the developmental period, lupus may worsen when stimulated by sex hormones. Doctors need to be able to ‘anticipate’ this. On the premise of minimizing the side effects of treatment, the intensity of treatment should be increased appropriately. This reduces the risk of future relapses and rebounds. In addition to failing to anticipate the evolution of lupus in adolescents, there is a common problem: underestimation of hormonal side effects. Glucocorticoids have a predictable potential for serious side effects on adolescent bone development, sex hormones, and more. Hormone-induced obesity, increased blood pressure, and blood sugar disturbances can reduce the long-term life expectancy of lupus patients. Full moon face, acne, etc. also affect beauty, and increased androgens in women can affect menstruation and fertility. Since it is important to intensify the intensity of adolescent lupus treatment, but there are concerns about hormonal side effects, what can be done? Rely on hydroxychloroquine, merti-macrolide, and others. Hydroxychloroquine has an irreplaceable role in minimizing the rebound of lupus flares, regardless of whether the lupus is mild, moderate, or severe. Whereas, MORTIMERS and CYCLOPHOSPHERAMIDE have a very definite effect in preventing lupus nephritis flare-ups and rebounds. On the contrary, there is not enough evidence to confirm that glucocorticoids can reduce lupus flares. Figure 4 Lupus treatment needs to be predictable SLE and lupus nephritis were once a serious threat to women’s health. Today, the prognosis of SLE and lupus nephritis has improved dramatically with standardized scientific treatment. However, non-standardized treatment is still not uncommon, and this has brought about many tragedies that could have been avoided ……