Hydroxychloroquine - lupus nephritis renal guidance

The label states that dose reduction may be necessary in renal or hepatic disease but supplies no percentage or eGFR dose table. Renal impairment is also a retinal-toxicity risk factor; apply the higher-risk ophthalmic monitoring instructions.

Proteinuria, with or without a moderate GFR reduction, has been reported. Consider drug-induced phospholipidosis as a possible cause of kidney injury in patients with underlying connective-tissue disease. Discontinue PLAQUENIL if renal toxicity is suspected or demonstrated on biopsy. A worsening creatinine value is therefore not automatically attributed to lupus activity or managed solely by a routine dose reduction.

KDIGO 2024 recommends hydroxychloroquine or an equivalent antimalarial for patients with systemic lupus erythematosus, including lupus nephritis, unless contraindicated. In its implementation guidance, eGFR <30 mL/min/1.73 m2 calls for a hydroxychloroquine dose reduction of at least 25%.

This is disease-specific guidance, not a complete product label or a universal malaria regimen. The guideline discusses flare prevention alongside retinal and cumulative cardiac toxicity. A renal reduction does not replace assessment of the starting dose, actual product, cumulative exposure and ophthalmic monitoring.