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Over the last decade, therapy for lupus nephritis in children has begun to shift from the provision of long-term steroids and intravenous cyclophosphamide to regimens with limited or no cyclophosphamide, lower steroid burdens, and increased reliance on oral mycophenolate mofetil. As the molecular immunology underlying the pathophysiology of lupus is further discerned, more targeted therapies, including the use of monoclonal antibodies against immune cells or cell signaling factors, may come to play a larger role in the treatment of pediatric lupus. Similarly, as experience with autologous stem cell transplantation for therapy-resistant disease is gained in adults, its potential applicability to such situations in children may be clarified. Over the next few decades, children with lupus will benefit as well from the identification of new biomarkers that are both sensitive and specific to disease activity, allowing clinicians to more readily assess response to therapy and diagnose disease flare.