Lupus nephritis (LN) is the most common serious organ manifestation of systemic lupus erythematosus (SLE), and significantly increases the morbidity and mortality of the patients in whom it develops.1 An intense effort by lupus patients, clinician-scientists, and the pharmaceutical industry has resulted in the approval of 2 new therapies for LN, with more on the way, leading to a sense of elation in the lupus community. However, the reality for patients who have already developed kidney failure from LN is not as optimistic.