How would you approach a patient with SLE and stage 4 LN who presents with persistent significant elevation in ESR, CRP and dsDNA despite improvement of symptoms and resolution of proteinuria on MMF and HCQ?  

Normalization of proteinuria in patients with class IV lupus nephritis (diffuse proliferative LN) is considered "clinical renal remission." However, these patients have approximately a 50% likelihood of having ongoing pathologic inflammation on renal biopsy. I would not recommend rebiopsy in this si...