I would first answer the question whether the proteinuria is due to active lupus nephritis (LN) or not and whether this can be addressed by adding/increasing the dose of an ACEi/ARB.  For active LN, I would switch to Voclosporin from Belimumab (continuing MMF) primarily because of concerns for...

Agree with my colleagues. Sometimes, persistent proteinuria could arise from secondary FSGS or lupus podocytopathy. These scenarios may be refractory to immunosuppression. Before escalating immunosuppression like Cyclophosphamide have a low threshold to repeat the renal biopsy to make sure active Cl...

AS THE EXCEPTION AND NOT THE RULE, I have added voclosporin to the care of multi-system lupus patients who were actively treated with belimumab and MMF in biopsy-proven WHO IV GN. (Both failed the European protocol of cyclophosphamide). Both responded to this combination. I began a taper of belimuma...