What factors do you consider when advising a patient with lupus nephritis on the safety of becoming pregnant?  

My approach, make sure you are in remission (tough to define, I agree) for at least 6 months. Get a high-risk OB. Take ASA for preeclampsia prophylaxis. Bump up your immunosuppression, perhaps add a bit of prednisone (15-20?). Get off MMF but change it to azathioprine. Consider a CNI if prote...

I agree with Dr. @Rodby's excellent suggestions (with just one exception!). I don't increase prednisone prophylactively for lupus pregnancy - I would only add or increase steroid if there is a flare. The risks of steroid in pregnancy impact both maternal and pregnancy outcomes, so we try to use them...

The question doesn't say whether: ❓The patient has active lupus nephritis (LN) with continued proteinuria urine: protein creatinine ratio > 800 mg/mg (UPCR > 800), and her lupus nephritis drugs are still being altered in the attempt to control her disease ❓OR If the patient had recent lu...