10 Enduring Scientific remarks in Nephrology

Two thousand years of Nephrology history:

Ten enduring scientific landmarks

2012.09.27 Kiwon Kim

About The Selection

By Leon Fine, MD

Vice Dean of Research and Research Graduate EducationChair, Biomedical Sciences in Cedars-Sinai Medical Center

1. The understanding that the kidneys are the source

of urine

Galen of Pergamum(131-201)

Galen

Greek doctor, philosopherPhysician of GladiatorsHis anatomy texts were based

primarily on the dissections of pigs and monkeys.

2. The understanding that blood circulates through the organs of the body, including the

kidneys, driven by the contractions of the heart

William Harvey(1578-1657)

“De Motu Cordis” 1628

William Harvey

 English physician who was the first person to describe completely and in detail the systemic circulation and properties of blood being pumped to the body by the heart

3. The understanding that there is a fine structure to the kidney which provides insight

into its function

Marcello Malphighi(1625-1694)

“On the Kidneys” 1666

Marcello Malpighi

A physician. The creator of a medical discipline, Microscopic Anatomy

Hooke's microscope, employed by Malpighi

Malpighi’s Observation

“Very small round bodies, like a coil of small worms” on the surface of the kidney. These were seen to be attached to the tortuous vessels [tubules] that, after short, sharp convolutions close the outer surface, run in a straight course toward the pelvis.

Bodies attached like apples to the blood vessels, the latter swollen with the black liquid (which he injected) and stretched out into the form of a beautiful tree.

Hwa C , Aird W C Am J Physiol Heart Circ Physiol 2007;293:H2667-H2679

©2007 by American Physiological Society

4. The understanding that there are different forms of kidney disease which cause

dysfunction of multiple organ systems

Richard Bright (1789-1858)

Richard Bright (Father of Nephrology)

First to describe the clinical manifestations of the kidney disorder known as Bright’s disease, or nephritis.

(edema, or swelling, and proteinuria, or presence of albumin in urine)

소변에 열을 가했을 때 coagulation 되는 것을 확인

Dropsy: An old term for the swelling of soft tissues due to the accumulation of excess water.

5. The understanding that there exists a discrete renal “unit” and that the glomerulus act as a

filter which is linked to a tubular system

William Bowman(1816-1892)

William BowmanHe is probably most famous,

however, for his work on the kidney, in which he identified the role of a tiny capsule (now known as Bowman's capsule) in carrying fluid from the kidney to the urinary system. He published his findings in a famous paper called On the Structure and use of the Malpighian Bodies of the Kidney (1842).

말피기 시대보다 훨씬 더 발달한 현미경을 이용

6. The understanding that glomerular filtration can be explained on physical principles : Renal physiology emerges as a discipline

Carl Friedrich Wilhelm Ludwig (1816-1895)

Carl Friedrich Wilhelm Ludwig

In 1847 he devised the kymograph to prove that blood is moved by mechanical forces, not the invisible "vital force." Ludwig's kymograph used a mercury manometer tube and a revolving drum to graphically record blood pressure variations and other vital signs. With later modifications, the kymograph became a standard tool for recording results of experiments

Kymograph 'wave writer'

Renal anatomy drawings by Ludwig

A. At top, a representation of the renal microvasculature, including (left) glomerular and (right) peritubular networks. Underneath, the relative total cross-sectional areas of different vascular segments are shown.

B. Pressure profiles across the capillary beds.

7. The understanding that the kidneys serve to maintain the constancy of the body fluids

Ernest Henry Starling

(1866-1927)

Ernest Henry Starling

“The function of the kidney is to keep the composition of the circulating fluid constant, and we can therefore alter the urine in any direction according to the nature of the changes we bring about in the composition of the body

- Starling EH. The Fluids of the Body London: Archibald Constable, 1909.

The kidneys as regulatory Organ

“The kidney presents in the highest degree the phenomenon of sensibility, the power of reacting to various stimuli in a direction which is appropriate for the survival of the organism; a power of adaptation which almost gives one the idea that its component parts must be endowed with intelligence.”

Starling forces regulating glomerular filtration

Jv= Kf[(Pc – Pi) – (πc – πi)]

8. The understanding that the kidney function can be determined at a cellular level

Hans H. Ussing (1911-2000)

9. The understanding that the certain renal diseases have an immunological

basis and are amenable to therapy

• Robert Schwartz and William Dameshek (1900-1965) " The effect of 6-mercaptopurine on primary and secondary

immune responses", 1959

• Richard A. Lerner and Frank J. Dixon (1920-2008) "Transfer of ovine experimental allergic glomerulonephritis

(EAG) with serum", 1966

10. The understanding that life can be extended in patients with end-stage

renal disease : Dialysis and Transplantation

• Willem Kolff (1911-2009) Use of Artificial Kidney in humans, 1945

• Belding H. Scribner (1921-2003) “Treatment of chronic uremia by means of

hemodialysis”, 1960

Closing Remarks by Dr. Leon Fine