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Richard Bright and the discovery of kidney disease
Nephrology is born, 1827 Fig 1 from Bright 1827. (Wellcome Images) Richard Bright (1789-1858), is widely regarded as the founder of the specialty of nephrology. He gave his name to Bright’s disease, which was used for over 100 years first as a term for any type of kidney disease, and later particularly for glomerular diseases.…
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The doctor’s bag circa 1910
This doctor’s bag is in the London Science Museum. Though dated 1890-1930 much of its contents look very early 20th century. What it doesn’t contain is significant. It belonged to John Hill Abram (1863-1933), a Liverpool physician who later became Professor of Medicine. He was also president of the Association of Physicians in 1928 –…
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Lithotomists: the first nephro-urological specialists
A sound has been passed from the penis into the bladder. With the genitalia held out of the way, and the patient strapped firmly to the table and held down by strong men, the surgeon cuts down onto the sound through an incision in the perineum. The incision is then widened a little, and the stone grasped…
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Home haemodialysis – how far can it go?
The home dialysis expansion of the 1960s and 70s Olga Heppel – one of the UK’s first home haemodialysis patients at home in 1964. Watch the movie at britishpathe.com. It came as a surprise to many that haemodialysis could be more than a short-term treatment. But pressures on capacity were immediate, varying methods being used…
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Marathon nephritis and postural proteinuria
When urinary abnormalities don’t indicate renal disease From Tom Brown at Oxford (1861) illust Sydney P Hall (1903 edition) Richard Bright’s 1827 description of the association of proteinuria with dropsy and serious kidney disease led to doctors of the 1800s kitting up with apparatus to test for proteinuria, long before they could measure blood pressure. Uroscopy…
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Lead nephropathy
The oldest interstitial renal disease? Lead pipe in Roman Bath. (Wikimedia Commons, see foot) Severe abdominal colic and gout caused by lead poisoning was described by Nikander in Ancient Rome. Acute poisoning also causes nerve palsies, particularly wrist-drop, encephalopathy, fits and sometimes death. Many patients became ill over weeks or months, with associated anaemia, malaise,…
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Monkey glands and the science of renal hypertension
Quack medicine and technology contributed to the discovery of Renin in 1898 A 1928 advert exploiting the Monkey Gland craze. Source In 1889 the renowned scientist Brown-Sequard at the age of 72 publicly recounted how how he felt rejuvenated after injecting himself with extracts of animal testis. This led to an extraordinary wave of quack…
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Blood pressure is linked to kidney disease in the 1870s
Revealed by Mahomed’s sphygmograph The discovery of hypertension and its linkage with renal disease came remarkably late. Richard Bright (1836) observed that “the hypertrophy of the heart seems, in some degree, to have kept pace with the advance of disease of the kidneys”. But he had no way to measure blood pressure, and even by…
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The invention of the dipstick
Test papers to dipsticks in 72 years The SSA test came first. From Cornell Vet School, with permission* For urinary protein detection the basic chemistry was established in the late 1700s, and until the late 1950s the standard test was still based on acidification and/or heating of urine to precipitate protein. Carrying bottles of acid…
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The perils of Salt
Dialysis finally forced recognition of its importance in kidney disease The Amazonian Yanomami Indians famously manage on only 50mg (1 mmol) of sodium chloride per day, while in more developed societies we struggle to keep our average intake below 100 times that level. Humans probably mostly evolved on diets more like that of the Yanomami.…
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The invention of IV fluid therapy
Thomas Latta first used IV saline in the 1832 cholera epidemic IV infusions at Edinburgh Royal Infirmary in the 1970s The second worldwide pandemic of cholera hit Scotland in 1832, travelling to Europe on ships from India, hence ‘Asian cholera’. This was – and remains – a terrible illness with a high mortality without medical…
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Aluminium poisoning
Draws attention to the importance of water quality in the 1970s Your dialysis team on the verge of the 1970s (Kings College Hospital 1969) Just as the outbreak of dialysis-associated hepatitis was dying down, a report (Alfrey et al) from Denver in 1972 described the first of many worldwide clusters of dialysis patients with an…
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Proteinuria: a bad thing since 400 B.C.
Indicates risk of renal failure and death Isaac Sarrabat 1600; Physician examining a urine flask. (US National Library of Medicine) Hippocrates (400 B.C.) described bubbles on the surface of the urine as indicating kidney disease and a long illness. Inspection of the urine (uroscopy, Fig 1) was a major part of the art of the…
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The renal data revolution from 1980
Renal units pioneer electronic records In the UK through the 1970s and 1980s renal units found themselves responsible for increasing numbers of patients, and services were stretched to capacity and beyond in seeking to cope with pressure of new starts. Managing their complex treatments and monitoring frequent test results was a major problem for understaffed…
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Obstetric renal failure
Alarming emergency and important public health marker Methodist Hospital, Dallas, 1966 (credit at foot of post) In the early days of dialysis obstetric renal failure was a major part of the work of a renal unit. Acute renal failure was estimated to occur in 1 in 1400 to 1 in 5000 pregnancies in the UK…