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...