Bring a large pot of salted water to a boil and drop in the tortellini. Cook it according to the package directions until it's just al dente, since it will keep cooking slightly once it hits the hot skillet. Before you drain it, scoop out two to three tablespoons of the starchy pasta water and set it aside.
While the pasta cooks, heat a large skillet over medium heat and add the sausage. Break it into bite-sized pieces as it cooks, letting it brown fully for about 6 to 8 minutes. Once it's cooked through, transfer it to a plate and leave roughly a tablespoon of the drippings behind in the pan.
Add the butter to the same skillet and let it melt over medium heat. Keep stirring as it cooks, since it will foam up before turning a deep golden color with little toasted specks on the bottom. This step only takes 3 to 5 minutes, but I stand right at the stove for it because brown butter can go from perfect to burnt in seconds.
Stir in the minced garlic and chopped sage, if you're using it, and let them cook for about 30 seconds until fragrant. Add the chopped kale next and cook for 2 to 3 minutes, stirring occasionally, until it wilts down and turns a deeper green.
Return the browned sausage to the skillet along with the drained tortellini. Toss everything gently so the tortellini doesn't tear, then pour in the reserved pasta water a little at a time until the sauce coats the pasta lightly. Stir in the Parmesan, season with salt, pepper, and red pepper flakes if you like heat, and finish with a squeeze of lemon juice before serving right away.