Past, present and future of lupus nephritis

INTRODUCTION: Our objective is to delineate the evolution of lupus nephritis (LN) histological classifications and management, from their origins to the present histopathological framework and treatment strategies, and to consider prospective future directions. AREAS COVERED: We describe the origins and progressive development of LN, particularly on histological classifications and pharmacological approaches to prevent renal disease progression and disease flares between 1950 and 2000 (the Past). Then, we discuss the remarkable advances achieved from 2001 to the present in the management, prognosis, and understanding of LN(the Present). Then, we envision a future shaped by the broader adoption of personalized medicine, the integration of novel biomarkers and artificial intelligence, and the innovative therapeutic strategies (the Future). Bibliography was searched in databases including PubMed, Medline, and Embase. EXPERT OPINION: Despite improvement in LN diagnosis and management, many patients experience a poor quality of life and may progress to renal failure or die from complications often associated with immunosuppressive therapy. Future strategies are expected to make substantial contributions to the field of LN, including the identification of novel biomarkers, the application of artificial intelligence, the implementation of personalized medicine, and the development of innovative therapies improving long-term renal survival and patients' quality of life.