The concept of 'glomerulonephritis' - The fascinating history of evolutionand emergence of a specialist's nosology focus on Italy and Torino

Though the term 'nephritis' first appeared in the 19th century, this word d id not bear the same meaning as it does today; indeed, for many years it wa s used to indicate 'renal diseases' (in the sense of Bright's disease) in a larger sense. This review summarizes the long gestation of the concept of 'glomerulonephritis' from the prehistory of medicine up to the beginning of the second half of the 20th century with emphasis on Italy and, in particu lar, on Torino, which was the capital of the Kingdom of Italy from 1861 to 1865. To the best of our kowledge, this is the first study reporting an epi demiology survey of Bright's disease in Italy from 1880 up to 1960. Towards the end of the 19th century, Bright's disease accounted for 26 deaths/year /10(5) population tin comparison with more than 200 from tuberculosis) in I taly, roughly paralleling that reported in the USA. At the beginning of the 20th century, Bright's disease was the seventh cause of death (almost 1 % of total deaths) in Italy. Furthermore, in Italy, as elsewhere, autopsy stu dies showed a higher percentage of deaths attributed to Bright's disease (5 -7%) in comparison with those obtained from vital statistics. In 1960, just before the beginning of renal replacement therapy, Bright's disease accoun ted for 15.7 deaths/year/10(5) population (= 1.46% of all deaths), roughly paralleling that reported in the United Kingdom (13.8/10(5) Population = 1. 25% of deaths). Probably, it was difficult to recognize the real incidence of chronic renal diseases leading to death in the 1960s, and vital statisti cs were able to furnish only approximate estimates. However, noteworthy is the fact that these values were very close to those estimated as being the annual need for renal replacement therapy (10-20 cases/year/10(5) populatio n).