How do you manage a pregnant patient with lupus who develops renal disease during pregnancy that is not due to pre-eclampsia?  

As the question implies, the first order of operations, when a pregnant lupus patient develops clinical features of nephritis, is to distinguish between the two most common etiologies, pre-eclampsia and lupus nephritis. The former is due to an imbalance between SFLT (soluble FMS like tyrosine kinase...

If preeclampsia is excluded, the most likely diagnosis will be lupus nephritis (LN) either de novo or a flare in an individual with a previous history of LN. It is important to realize that if a patient had LN in the past their kidneys will likely have some chronic injury and they may even have pers...