OBJECTIVE: To evaluate the role of ultrasonic viscoelastic imaging in predicting proliferative lupus nephritis (PLN). METHODS: We prospectively used ultrasonic viscoelastic imaging to evaluate 143 patients with lupus nephritis (LN), who underwent kidney biopsies from May 2023 to June 2024. Sixty healthy volunteers served as the control group. Patients were categorized as 90 cases of PLN, and 53 cases of nonproliferative lupus nephritis (nPLN). Ultrasonic viscoelastic imaging was employed to quantitatively analyze kidney cortex elasticity (Emean), viscosity coefficient (Vmean) and dispersion coefficient (Dmean). Semi-quantitative assessment of the lesion tissues was conducted based on the activity index and chronic index scoring system established by the National Institutes of Health (NIH) in 2018. The relationship among clinicopathological, conventional ultrasound factors and viscoelastic parameters was evaluated. RESULTS: Viscoelastic parameters (Emean, Vmean, and Dmean) significantly differed among the healthy control, PLN, and nPLN groups (all CONCLUSION: As a noninvasive examination method, ultrasonic viscoelastic imaging is beneficial for identifying PLN.