History of Nephrology

The initial recognition of kidney disease as independent from other medical conditions is widely attributed to Richard Bright’s 1827 book “Reports of Medical Cases,” which detailed the features and consequences of kidney disease. For the next 100 years or so, the term “Bright’s disease” was used to refer to any type of kidney disease. Bright’s findings led to the widespread practice of testing urine for protein — one of the first diagnostic tests in medicine.

The study of kidney disease was furthered by William Howship Dickinson’s description of acute nephritis in 1875 and Frederick Akbar Mahomed’s discovery of the link between kidney disease and hypertension in the 1870s. Mahomed’s original sphygmograph, created when he was a medical student, was improved in 1896 by Scipione Riva-Rocci, of Italy, with the use of a cuff to encircle the arm.

In the twentieth century, investigators such as Homer Smith revealed the underlying physiology of the kidney. Smith’s findings led to important medical therapies for multiple kidney diseases. As technology improved, therapy in the field of nephrology was further advanced with the first successful use of hemodialysis in 1945 by Willem Kolff. Shortly thereafter, in 1954, the first successful kidney transplantation was performed in identical twins in Boston by Joseph E. Murray. With further work in immunology, Murray and his team were later able to transplant kidneys into unrelated recipients with the use of immunosuppressive therapy. One of the first successful case seriesdescribing the use of immunosuppression (azathioprine or 6-mercaptopurine and glucocorticoids) was reported in the New England Journal of Medicine in 1963 by Murray and colleagues.

Today, clinical nephrology continues to advance with many forms of renal replacement therapy — both acute and chronic — including hemodialysis, peritoneal dialysis, hemofiltration and hemodiafiltration, the use of erythropoietin for anemia in chronic kidney disease, treatment of renal osteodystrophy, ongoing improvements in immunosuppression for transplantation, and specific treatments for many nephropathies.