What is your preferred add-on for membranous lupus nephritis (2.2 grams of protein, normal creatinine) in a young woman who is currently on hydroxychloroquine and mycophenolate 1500 mg 2x daily?

Persistent proteinuria in patients with any ISN/RPS class of LN is problematic recognizing goal is to achieve EULAR targets of uPCR < 25% at 3 months, < 50% at 6 months, and < 0.5 - 0.7 at 12 months compared to baseline. Proteinuria is renal tubulointerstitium toxic inducing pro-inflammatory and fib...

First, I’ll assume that due diligence was done with the following:

• renal protective therapies like ARB/ACEi, SGLT2I have been used as part of therapy,
• HTN has been well controlled,
• HCQ drug levels have been monitored to ensure adherence and keeping the level at 1000-1200 ng/mL (my goal for lupus ne...