Drs. Ruby Patel and Rajdeep Pooni present Grand Rounds using a 12-year-old case to illustrate pediatric systemic lupus erythematosus and class IV lupus nephritis, covering presentation, biopsy findings, and pathology. The talk explains diagnostic criteria and typical lab features. They summarize current management including 2024 ACR guidance on induction therapies (steroids, mycophenolate, cyclophosphamide, and biologics), monitoring for complications and medication side effects, vaccination precautions for immunocompromised patients, and the pediatrician’s role in long-term coordination of care.