The treatment of lupus nephritis has seen significant advances during the past 
decade mainly due to the publication of well-designed randomized clinical trials 
(RCTs). The choice of treatment is guided by the histopathologic classification 
but is also influenced by demographic, clinical, and laboratory characteristics 
that allow for the identification of patients at risk for more aggressive 
disease. For the induction arm, low-dose cyclophosphamide regimens and 
mycophenolate mofetil have been validated as alternatives to the established 
National Institutes of Health regimen of high-dose cyclophosphamide; for the 
maintenance phase, azathioprine and mycophenolate compete for treatment of first 
choice. Rituximab is efficacious in real-life clinical practice but ineffective 
in clinical trials. The role of recently approved belimumab in lupus nephritis 
eagerly awaits further documentation. Aggressive management of comorbid 
conditions, such as hypertension and dyslipidemia, is of utmost importance. 
Here, we review the latest advances in lupus nephritis therapy with a focus on 
recent RCTs as well as new biologic agents under development. Furthermore, we 
propose a therapeutic algorithm in an effort to facilitate clinical 
decision-making in this gradually changing landscape. Upcoming European and 
American recommendations should provide further clarification.