%0 Journal Article
%T The Grand Challenge of Nephrology
%A Howard Trachtman
%A Thomas Benzing
%A Sanja Sever
%A Raymond C. Harris
%A Jochen Reiser
%J Frontiers in Medicine
%D 2014
%I Frontiers Media
%R 10.3389/fmed.2014.00028
%X Pre-modern history of nephrology The kidneys have always been an object of mystery and study from time immemorial. Confucius considered them to be one of the vital organs together with the brain and heart. The Talmud suggests that the kidneys are the seat of the soul and the liturgy of the high holidays describes God as discerning what is in the heart and kidneys of man. Various psalms and passages from the Bible consider heart and kidneys as symbol of somatic and mental integrity (1). The Quran implies important functions are resting within the kidneys. Richard Bright in 1827 was one of the first clinicians to recognize the connection between renal damage and illness. Although the label Bright¡¯s disease is no longer in use, it is a testament to the astute acumen of this early 19th century physician. Although he is thought to have described a patient with post-infectious glomerulonephritis, the small, shrunken kidneys that are preserved in Guy¡¯s Hospital in London do not provide a clue about the cause of the chronic disease. They only illustrate the consequences of renal scarring. Frederick Munk was the first to describe minimal change nephrotic syndrome in the 1910s and coined the term ¡°lipoid nephrosis¡± for the disease called ¡°dropsy¡± based on the appearance of the kidney tissue and urine. Although acute kidney injury was not a new entity, it was first diagnosed in living patients who suffered crush injury and rhabdomyolysis-induced kidney damage during the London Blitz in World War II. However, until the 1950s, there was very limited access to the laboratory tests required to establish a diagnosis of kidney disease and there was no impetus to change things because there were no treatments for patients with renal disorders. Entry of nephrology into modern medicine In 1954, John P. Merrill and Joseph Murray performed a kidney transplant between two identical twins and ushered nephrology into the modern age (2). There had been a number of pioneering physicians and engineers who were working on the development of an artificial system to replace kidney function when the organ fails. However, Merrill¡¯s surgery represented a cure for CKD by implanting a new functioning kidney into a patient who had irreversible loss of organ function. He was fortunate to have access to an identical sibling and he could avoid the hazards of organ rejection due to immunologic disparity between the kidney donor and recipient. Over the next decade the biology of tolerance and rejection was clarified by Peter Medawar leading to the discovery of immunosuppressive drugs. This has
%K Nephrology
%K Kidney
%K End stage kidney disease
%K basic science
%K clinical setting
%U http://www.frontiersin.org/Journal/10.3389/fmed.2014.00028/full