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Active lupus nephritis poses severe maternal and fetal risks in pregnant patients. Management in pregnancy is challenging and limited by lack of pregnancy-safe medication options. Preeclampsia is an associated maternal risk that shares many clinical features with lupus nephritis, often making it difficult to identify the primary disease process. In this report, we present a case of severe preeclampsia superimposed on active lupus nephritis in a 25-year-old pregnant female. We highlight the risks and management options for lupus nephritis in pregnancy, the overlaps in presentation between lupus nephritis and preeclampsia, and techniques to clinically distinguish between the two.