I agree with @quiltergirl2 in that it is really “difficult when your medical team are at odds with your treatment”. That can be a more likely problem when you have more than one condition to deal with. I have made a point of using a large health system where the specialists all have access to the same records, can collaborate and generally are supportive of each other. Unfortunately sometimes a specialty has the opinion that their area should have highest priority. In your situation hearts are very important but so are kidneys. I like the suggestion to get a second opinion. Could you do that? Could you ask the nephrologist if there are other tests to resort to besides kidney biopsy to get answers regarding lupus nephritis? (I’ve had kidney biopsies; they aren’t fun!). I’ve never had any heart problems, thank God! But I did join the masses of people that started a low dose aspirin to protect myself from heart problems and stroke. I think that was many years ago at the advice of my nephrologist. A few years back the same nephrologist told me to discontinue it because the new thinking is that the risk of hemorrhages is greater than the risk of heart attack or stroke! It is hard to be a compliant patient when scientific opinions change over time!