Immunosuppressive therapy in glomerular diseases

333 In a humble assessment of his own professional achievements, professor Tadeusz Orłowski paid great attention to the studies that aimed to elu‐ cidate the role of immunosuppressive therapies in glomerulopathies. In fact, to those who were his close co‐workers in the First Department of Medicine and then Transplantation Institute and to those who participated in the studies, it was essential as well. Glomerulonephritis (GN) continues to be the third most common cause of end‐stage re‐ nal failure. Recent US Renal Data System indi‐ cates that patients with GN constitute 8.2% of in‐ cident and 15.6% of prevalent dialysis patients in the United States.1 This percentage very like‐ ly underestimates the incidence of GN, main‐ ly due to two factors: an overestimation of hy‐ pertensive disease as a cause of end‐stage renal disease in patients with late clinical presenta‐ tion and scarce symptomatology and a low rate of kidney bio psies. In children and young adults, GN is more prevalent in the dialysis population than in the elderly and carries significant burden to the overall health and well‐being of the society. Although progress has been made in the under‐ standing of the bio logy/function and the genet‐ ics of glomerular cells, as well as the response of glomerular structure to the immune/inflam‐ matory injury, the therapeutic inter ventions are far from being uniformly successful and accept‐ ed. This was even more evident in the early 1950s when a young physician, Tadeusz Orłowski, start‐ ed his career. At that time (1955–1965), GN was the most common renal disease in Poland and Europe, lead‐ ing to renal failure and to death, since neither di‐ alysis nor transplantation was widely available. Thus, the work toward better understanding and treating GN was indeed the priority. The early 1950s were also a time of confusion in the descriptive pathology of GN, especially when Arthur Ellis introduced a simplified classi‐ fication, based on long‐term studies of 400 pa‐ tients with nephritic syndrome. Ellis divided GN into type I, those with inflammatory nephritis (mainly, as he thought, due to streptococcal or other infection), and type II, degenerative dis‐ ease (membranous and lipoid nephrosis).2 Clinical REVIEW ARTICLE