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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 4  |  Page : 373-377
History of Development of Nephrology


Consultant Nephrologist, Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

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How to cite this article:
Al-Attar BA. History of Development of Nephrology. Saudi J Kidney Dis Transpl 1996;7:373-7

How to cite this URL:
Al-Attar BA. History of Development of Nephrology. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Jan 21];7:373-7. Available from: http://www.sjkdt.org/text.asp?1996/7/4/373/39406
Nephrology was not a definite field of Medicine before the sixties of this century. Even Richard Bright and Peire Raye the founders of Nephrology did not use this terminology in the 19th century. If we look up this word in any medical dictionary, whether English, French or German published during that time, like the one by Morin in 1809, we would find "nephrology" defined as "the section which deals with the anatomy of the kidneys" [1] .

Nephrology was at that time part of Urology, inspite of the many advancement in knowledge about the kidney function and its characteristics during the last three centuries. It was a long incubation period inside urology before Nephrology as a definite field in medicine was born. For a long time, the urologists considered kidney diseases as merely manifestations of urological obstruction, and their pathogenesis as obstructive in the first place. In 1739 a book of urology mentioned that the only treatment needed for anuria was to insert a catheter inside the bladder by a urologist [1] .

There are important dates which can be considered as milestones in the history of Nephrology. Galen, was the first anatomist to recognize the urine producing function of the kidney. Later on, with the invention of the microscope, new doors opened for the study of renal structure. Bellini proved the canalicular organization of the paranchyma. Malpighi then described the Glomerulous and its relation to the intrarenal extretory ducts in 1680 [2] . This was followed by the first description of symptoms and signs of renal disorders by Dekkers from Leyden who described proteinuria in 1694. Catugno from Italy elaborated more about proteinuria in 1756. Also Furcroy described urea in 1797. Apart from that, we do not find much data related to Nephrology during that century. Prevost from Switzerland and Dumas from France clarified the events following ne-phrectomy and called it "uremia" in 1821. Bright from London collected all the clinical and anatomical signs of acute and chronic renal disorders, which might cause death, and found the relationship between the renal injury and the appearance of edema and proteinuria, besides the gross appearance of the kidneys in 1827. That was the first official publication which formed the real start of Nephrology which enabled it later to become a distinct branch of medicine.

The Bowman capsule of the glomerulous was named after Bowman who described it in his research in nineteenth century. In the period between 1830 and 1860, Bowman and Ludwick worked closely on the Glomerulous and its connection with the proximal tubule and also the peculiar circulation of the glomerulous which involves the afferent and efferent arterioles as well as the arcuate small arteries which branch out from the main renal artery's divisions and subdivisions. They also described the circulation in the renal medulla. In 1838 Solon explained "albuminuria" followed by Simon in 1843 who described the protein cylinders. In 1844, Ludwick showed the relationship between the blood pressure and glomerular filtration [3] . By 1875 the classification of casts was complete. The work of the 19th century microscopists culminated in Rieder's book of clinical microscopy, which described each elements of urinary sediment [4] . In 1898 Koranyi described the inability of the kidney to concentrate urine in case of renal failure. Many attempts took place at that time to classify renal diseases. Accordingly, we have important names and dates. The first was Rayer from Paris who described the inflam­mation of the kidney as "Nephritis" in 1840 and the second person was Langhans who put the terminology of "Glomerulonephritis" in 1879 to describe the inflammation of the kidney secondary to glomerular injury [3] .

In the first half of this century there were advancement in many aspects of this branch of medicine. The Juxta glomerular apparatus was described by Oberling in 1927 and the Maculla Densa by Zimmermam in 1929. It is believed that the advancement in the knowl­edge of the ultra-structure of the kidney helped the physiologists understanding better the function of the kidneys and contributed to the continuous progress of research in this field [3] .


   The Excretion Function of the Kidneys Top


The definition of renal clearance was introduced by Van Slyke from Boston in 1928. His work was extended by Smith from New York in the period 1930-1932 when the latter proved that creatinine clearance was close to the insulin clearance in order to calculate the glomerular filtration rate. Later between 1935 and 1950, Pits and Smith studied the tubular absorption and its changes related to filtration rate and compared the effects of para-amino­hippuric acid and glucose [3] .


   The Kidney as an Endocrine Organ Top


In 1898, Tigerstedt was the first to describe renin as a factor effecting blood pressure and secreted by the kidney. This was followed in 1938 by the research of Page who clarified the nature of this hormone and the mechanism of its effects on blood pressure. In the period between 1938 and 1945, Goormatigh related the synthesis of renin to the juxta glomerular apparatus. In 1957, erythropoietin was described by Jacobson as a renal hormone responsible for the production of red blood cells and that it might be secreted by the glomeruli. Urokinase was discovered by Sobel in 1952 as an activator of plasminogen to plasmin. The structure of Vitamin D and the mechanism of its activation by the kidney, besides the role of parathormone and hypophosphatemia in this activation were discovered by Deluca and Kodicek in the period between 1966 and 1971. The relationship of the kidney to electrolyte and water homeostasis and the effects of the various hormones through the kidneys were first launched by the research of Bernard from Paris between 1930 and 1950 [5],[6] . His colleagues, Petters, Van, Slyke, Gamble, Henderson and Pitts, in the United States of America extended the research on this subject and applied the results to clinical practice [3],[7] . It is believed that these achievements helped the progress of clinical nephrology which made the correction of dehydration an amazing event in medicine in the early forties of the twentieth century.


   Further Research of the Renal Function Top


Between 1930 to 1945, Oliver concentrated his research on nephrons and described the relationship between their loss and the progress of the renal failure. In the 1950. Brun and Iversen from Copenhagen described the technique of the kidney biopsy by a needle which led later to the improvement of the clinico-pathological studies of the renal disorders. In 1955, Platt proved the presence of Bright islands in the kidneys which are formed of healthy nephrons compensating for the function of the damaged ones [3] .

Bricker et al characterized further the events which usually take place in the compensating nephrons in case of renal insufficiency. Their research showed between 1960 and 1975 the disturbances of water, sodium, potassium, and phosphorus following the drop-out of nephrons [8],[9] . Brenner's research between 1975 and 1985 showed the relationship between hypertrophy of the kidneys due to the increase in the glomerular filtration rate, as in diabetes, and the development of the hyalinosis of the glomer-uli [10] . Later Broyer et al proved in rats that restriction of protein intake delayed the deterioration of glomerular filtration rate, which had an impact on the recent management of renal insufficiency [11],[12] .


   Renal Replacement Therapy Top


Kolff from Holland used the first hemo­dialysis machine in 1943 [13] , followed by Alwall from Sweden in 1945 who used the dialysis machine in the treatment of acute renal failure [14] . The technique of dialysis improved over the years from many aspects including use of heparin, dialysers with semi­permeable membranes, and control of sodium and potassium homeostasis which contributed to the safety and efficiency of dialysis for acute and chronic renal failure [15],[16] . The innovation by Scribner from Seattle (U.S.A.) of making an arterio venous shunt as an access for hemodialysis [17] led to the wide spread use of hemodialysis between 1960 and 1965 [18] .

Renal transplantation had its start between 1956 and 1959 when Merrill from Boston, and Hamburger from Paris performed renal transplantation between identical twins fol­lowed by allografting from related and unrelated donor and recipient groups [19],[20] . In 1967 Dausset from Paris discovered the HLA system which helped in the later success of transplantation and the progress of immune techniques and genetics [21],[22],[23],[24] .

Popovich from U.S.A. and Oreopoulos from Canada developed a new technique called continuous ambulatory peritoneal dialysis in the period from 1976 and 1978 [3] .

The first international congress of Nephrology held in Geneva 1960 was a real milestone for Nephrology to become a distinct branch of internal medicine. The scientists of anatomy and physiology besides clinicians had one goal to pursue: better understanding of the function of the kidney. During that congress they agreed, for the first time, to draw a tortuous nephron figure instead of the straight one known before. The participants also agreed to consider the functions of all nephrons as one integrated unit, they draw the detailed figure of the renal structure. As well, they presented the acute renal failure and its clinical and anatomical manifestations in this connection to understand its pathogenesis. During the same congress Scribner presented the experience of four patients treated by hemodialysis and introduced the possibility of the wide spread use of this technique in renal replacement therapy [1] .

After that congress "Nephrology" found its way to the medical dictionaries in English and French as a distinct specialty from Urology.


   The Contributions of Nephrology to Medicine in the Past Thirty Years Top


The Birth of Medical Reanimation:

Since cessation of renal functions leads to disturbance in the internal homeostasis. The nephrologists were the first to notice such disturbance and to correct it. The idea of intensive care units stemmed from that and helped many patients later more than the help they got from the discovery of antibiotics [1],[25] .

Organ Replacement Therapy by Machine:

The nephrologist were the first to use a machine to replace function of failing human 376 organ. The cardiologists and hepatologists are still far behind in perfecting the replace­ment of heart and liver functions by machines, though some progress has been made in this regard [26],[27],[28],[29] .

3) Contribution to Nosology (classify­cation of diseases):

The nephrologists were the first to attempt to classify the diseases depending on biopsy of an organ. This helped finding the relationship between the pathogenesis and the clinical manifestations of the kidney diseases. Later, scientists of other branches of medicines used similar methods used earlier by the nephrologists [30] .

4) Contribution to Immunology:

Nephrologists were pioneers in denoting the immunological origin of diseases in a human organ [31] . They described glomerulonephritis auto-immune diseases like systemic lupus nephritis, Good Pasture's syndrome and the events in renal transplantation. Many nephrologists even converted to immuno­logists and described the relationship between the immune system and the effects of antigens and antibodies. Circulating complements in the blood were first defined by nephrologists who also contributed to the development of knowledge about Cellular immunology [32] .


   Current and Future Research in Nephrology Top


The nephrologists have moved forward to a better understanding of the pathogenesis of the kidney diseases at the molecular level, in order to have more effective role in prevention of the development of these diseases, which remains idiopathic at large. At 5 present, such role is devoted by nephrologists to delay progression of renal failure through temporizing some of the risk factors such as control of diabetes mellitus and/or hypertension [33] . The present results of the in-vitro experiments, and the in­-vivo animal models are promising of unrevealing the 7-complicated immunological mechanisms behind lupus nephritis [34] , the role of the complement receptor on complement-mediated glomerulonephritis [35] , the role of phagocytosis of the endothelial cells of the renal glomeruli [36],[37],[38] , fibroblasts growth factors and platelet derived growth factor [39] in induction of renal tissue injury and the development of glomerulonephritis.

As understanding of these areas evolves, numerous new therapeutic strategies can accordingly be deviced, including agents which block or inhibit effects of complement, oxidants, proteases, growth factors, and other cytokines [39] .

At present, renal and other organ transplantation are the best known methods of replacement of the function of the damaged organs. Future developments of the immunosuppression, artificial organs and xenotransplantation may change the current medical practices of management of end stage organ failure [40] .

Finally, it is a rare situation to find a branch of medicine, which has gathered so many relationships with basic sciences and clinical practice like nephrology which can be considered a distinct specialty in modern medicine.

 
   References Top

1.Hamburger Jean. Naissanoe et essor de la nephro-logie. Nephrologie 1980;l:l-2.  Back to cited text no. 1    
2.Mezzogiorno V, Mezzogiorno A, Passiatore C. A contribution to the history of renal structure knowledge. Anat Anaz 1993;175(5):395-401.  Back to cited text no. 2    
3.Richet G. Historique et introduction a la Nephrologie d' aujourd'hui. Encycl Med Chir (Paris, France), Rein-organes genito-urinaires, 18040 B20  Back to cited text no. 3    
4.Fogazzi GB, Cameron JS, Ritz E, Ponticelli C. The history of urinary macroscopy to the end of the 19th century. Am J Nephrol 1994;14(4­6):452-7.  Back to cited text no. 4    
5.Bernard C, Gros D, Raymond G, Gargouil YM. Nonspecific effects of allethrine on the ion permeabilities of rat embryo myocardium. C R Seances Soo Biol Fil 1969;162(ll):1998-2003.  Back to cited text no. 5    
6.Bernard C, Gargouil YM. Successive acquiring by the rat embryo of specific permeabilities of the myooardia membrane. C R Acad Sci Hebd Seances Acad Sci D 1970;270(ll):1495-8.  Back to cited text no. 6    
7.Gamble JL Jr, Hess RC Jr. Mitochondrial electrolytes. Am J Physiol 1966;210(4):765-70.  Back to cited text no. 7    
8.Danovitch GM, Bourgoignie J, Bricker NS. Reversibility of the "salt-losing" tendency of chronic renal failure N Engl J Med 1977;296(l):14-9.  Back to cited text no. 8    
9.Humes HD, Narins RG, Brenner BM. Disorders of water balance. Hosp Pract 1979;14(3):133-45.  Back to cited text no. 9    
10.Hostetter TH, Troy JL, Brenner BM. Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int 1981;19(3):410-5.  Back to cited text no. 10    
11.Broyer M. Conservative treatment of chronic renal insufficiency in children. Paediatrician 1979;8(5-6):297-306.  Back to cited text no. 11    
12.Diaz M, Kleinknecht C, Broyer M. Growth in experimental renal failure: role of calorie and amino acid intake. Kidney Int 1975;8(6):349-54.  Back to cited text no. 12    
13.Legrain M, Sue JM. Nephrologie 1981:1-10.  Back to cited text no. 13    
14.Alwall N. Dialysis activity in Sweden 1946 till 1966 and its perspective planning. Dtsch Gesund-heitsw 1968;23(17):769-73.  Back to cited text no. 14    
15.Alwall N. Technical possibilities of therapy and rehabilitation in chronic renal insufficiency in relation to hospital care problems. Nord Med 1966;75(18):508-9.  Back to cited text no. 15    
16.Schmer G, Teng LN, Vizzo JE, et al. Clinical use of a totally heparin grafted hemodialysis system in uremic patients. Trans Am Soc Artif Intern Organs 1977;23:177-84.  Back to cited text no. 16  [PUBMED]  
17.Jungers P. L' essentiel sur I hemodialyse, 3rd edition 1988:11.  Back to cited text no. 17    
18.Alwall N.Dialysis treatment in chronic renal insufficiency in the USA and europe a short survey. Nord Med 1966;75(18):501-2.  Back to cited text no. 18    
19.Merrill JP. Present status of kidney transplantation. Med Times 1967;9S(4):403-15.  Back to cited text no. 19    
20.Merrill JP. Transplantation immunology 1957- 1975. Ann Immunol Paris 1978;I29(2-3):347-52.  Back to cited text no. 20    
21.Dausset J. Biological implications of the main histocompatibility system: the HLA system. C R Seances Soc Biol Fil 1974;168(2-3):160-72.  Back to cited text no. 21    
22.Dausset J, Hors J, Busson M. Histocompatibility and kidney transplantation. Basel Karger 1976;728-35.  Back to cited text no. 22    
23.Dausset. The HLA complex. I. Immunogenetics of the HLA system. The HLA-A, B and C Allelic 37 series. Nouv Presse Med 1976;5(20):1301-4.  Back to cited text no. 23    
24.Dausset J. Physiology and pathology of the HLA complex. Ann Immunorparis 1977;128(l-2):363-9.  Back to cited text no. 24    
25.Safar P. Philosophy, history and future of reanimation. Anaesthesist 1974;23(12):507-19.  Back to cited text no. 25    
26.Moritz A, Rokitansky A, Schima H, et al. Mechanical bridge to transplantation with the Vienna heart in TAH and LVAD configuration.Int J Artif Organs 1992;15(3):147-50.  Back to cited text no. 26    
27.Emery RW, Joyce LD, Prieto M, Johnson K, Goldenberg IF, Pritzker MR. Experience with the symbion total artificial heart as a bridge to transplantation. Ann Thorac Surg 1992;53(2):282-8.  Back to cited text no. 27    
28.Demetrio AA, Rozga J Podesta L, et al. Early clinical experience with a hybrid bioartificial liver. Scand J Gastroenterol Suppl 1995;208:111-7.  Back to cited text no. 28    
29.Wintermantel E, Cima L, Schloo B, Langer R. Angiopolarity: a new design parameter for cell transplantation devices and its application to degradable systems. ASAIO Trans 1991;37(3):334-36.  Back to cited text no. 29    
30.Tareev EM, Serov VV. Modern nosology and the pathomorphism of kidney diseases Arkh Patol 1975;37(7):3-11.  Back to cited text no. 30    
31.Hamburger J. Transplantation immunology at the service of medicine. II. Study of diseases of the grafted kidney and lessons drawn by nephrology. Nouv Presse Med 1973;2(2):77-80.  Back to cited text no. 31    
32.The Jean Hamburger Symposium: The impact of immunology on nephrology and transplantation, Paris, France Transplant Proc 1982;14(3):465.  Back to cited text no. 32    
33.Cameron JS. The future of nephrology with special record to advances in treatment. Kidney Int Suppl 1992;38:203-14.  Back to cited text no. 33    
34.Kootstra CJ, Bergijk EC, Veninga A, et al. Qualitative alterations in laminin expression in experimental lupus nephritis. Am J Pathol 1995;147(2):476-88  Back to cited text no. 34    
35.Couser WG, Johnson RJ, Young BA, Yen CG, Toth CA, Rudolph AR. The effects of soluble recombinant complement receptor 1 on complement­mediated experimental glomeruli­nephritis. J Am Soc Nephrol 1995;5(11): 1888-94.  Back to cited text no. 35    
36.van-Velthuysen ML, May en AE, Prins FA, de-Heer E, Bruijn JA, Fleuren GJ. Phagocytosis by glomerular endothelial cells in infection-related glomerulopathy. Nephrol Dial Transplant 1994;9(8):1077-83.  Back to cited text no. 36    
37.Lovett DH. Immunologic glomerular disease-new prospects for specific therapy. West J Med 1994;160(5):481-2.  Back to cited text no. 37    
38.Remuzzi G, Zoja C, Bertani T. Glomerulonephritis. Curr Opin Nephrol Hypertens 1993;2(3):465-74.  Back to cited text no. 38    
39.Couser WG. Mediation of immune glomerular injury. Clin Investig 1993;71(10):808-ll.  Back to cited text no. 39    
40.Mito M. Present and future in organ transplantation. Hokkaido Igaku Zasshi 1995;70(2):219-20.  Back to cited text no. 40    

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Correspondence Address:
Besher A Al-Attar
Consultant Nephrologist, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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