Lupus nephritis (LN) is a common complication of systemic lupus erythematosus (SLE), occurring in approximately 38.3% of patients. patients with LN have a higher incidence of end-stage renal disease (ESRD) and death. patients with LN are younger and more often of non-white ethnic background than other SLE patients. Researchers from the departments of rheumatology, pharmacy and pathology at Queen Elizabeth II Health Sciences Centre and Dalhousie University analyzed 1,827 newly diagnosed SLE patients enrolled in the International Systemic Lupus Erythematosus Collaborative Clinical Study (SLICC). Patients from the United States, Europe, Canada, Mexico and Asia received standard treatment regimens, and the results of the study were published in a recent issue of Rheumatology. This study emphasizes that patients with SLE should be screened for LN and, if they do have LN, should be followed up regularly. Early and aggressive treatment is important, but it does not mean that patients need to be given more drugs, but rather better follow-up. The study included patients from 1999-2012 with a mean age of 35.1 years at baseline, 89% of whom were women. The mean follow-up was 4.6 years, with data collected annually, including estimated glomerular filtration rate (eGFR), proteinuria, ESRD and health-related quality of life. The study was not initially designed to assess renal outcomes, so some information was obtained from a retrospective case review. A total of 700 patients with LN were included, of whom 566 patients (80.9%) had LN at study entry, and LN was diagnosed according to American College of Rheumatology (ACR) criteria or renal biopsy results, if available. Compared to other SLE patients, those with LN have a higher incidence of hypertension, plasmacytosis, neurological disease, and immune disease, but less skin disease, arthritis, and antinuclear antibodies. Glucocorticoids and immunosuppressants were more commonly used in patients with LN, but antimalarials were less frequently used: only 49.1% of LN patients were already taking them at study entry, and this number increased to 72% as the study progressed. patients with the most severe LN had the lowest health-related quality of life scores. Patients with LN also had a higher risk of death. In addition, patients who were taking antimalarials at study entry were not less likely to progress to ESRD, but they had a longer survival. These numbers are an improvement from more than a decade ago, but there is still a long way to go to improve outcomes for these patients. In a review accompanying this study, Professors Anselm Mak and Sen Hee Tay from the Department of Rheumatology at Yong Loo Lin Medical University in Singapore wrote: Notably, early use of the antimalarial drug hydroxychloroquine, increased rates of renal biopsy and prospective evaluation of health-related quality of life are critical for patients with LN, not only to improve survival but also to improve overall care for patients with SLE. Notably, because these patients are treated at academic centers, they may be treated more aggressively than those with SLE who are treated in the community. Because patients were enrolled in the study soon after diagnosis (on average, 6 months after diagnosis), they were younger and had shorter disease duration than the overall SLE patient population. It should also be noted that the background of the study population included a large proportion of white patients, and because of the propensity for better outcomes in this group, mortality and prevalence in this study may have been lower than in the general population.