Lupus nephritis: an historical perspective 1968-1998

Lupus is now regarded as a syndrome which results from several related auto-immune processes, although the exact mechanisms of how the disease arises in susceptible individuals remain obscure. When the San Carlo meetings began in 1968, much less was known about the pathogenesis of autoimmunity, but the presence of autoantibodies and autoreactive cells had been worked out, the patterns of the disease and its clinical and histological expression in the kidney were well described. At that time, however, the prognosis for severe forms of lupus nephritis was miserable, although patients either milder disease might survive for decades. During the late 1950s and 1960s relatively effective palliative treatment first with corticosteroids and then cytotoxic drugs were introduced, which disappointingly remain the principal treatments 40 years later, although they have improved the prognosis of severe lupus nephritis to equal that of milder forms. However, better understanding of the immune reaction promises newer forms of more precisely-targeted treatment for the near future.