Lupus nephritis remains a strong predictor for death and the development of end-stage renal disease (ESRD) in patients with SLE. Definition of renal involvement varies but overt renal disease is found in at least one-third of SLE patients, with up to 60% of adults and 80% of children developing lupus nephritis. Clinical presentation has been found to bear little relationship to renal biopsy findings. Renal biopsy is therefore informative for all patients with SLE with abnormal urinalysis or reduced renal function, even with serum creatinine in the normal range, to guide treatment decisions. Current treatment regimens combine corticosteroids with cyclophosphamide, azathioprine or ciclosporin, although mycophenolate mofetil has received much recent attention as a potentially superior immune suppressive. The toxicity of current drug regimens contributes significantly to existing morbidity and mortality. A new era of biological therapies holds the potential for safer, more effective therapies in the future.