In a patient with Class IV lupus nephritis and cardiomyopathy who has received cyclophosphamide, how do you approach the use of biologics such as belimumab or voclosporin in the setting of ongoing proteinuria?  

Voclosporin and belimumab have both been shown to have efficacy in the treatment of lupus nephritis, and are exciting options to consider, as also recommended in the ACR guidelines. One of the key questions for ongoing proteinuria is the degree of active disease vs chronicity, and the role of a (rep...