Manual Hemodialysis (Contributions to Nephrology)

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His work was later continued in several other countries, especially in Boston, where his artificial kidney was modified by J. Merrill and used in clinical practice as the Kolff-Brigham kidney. Then in Willem Kolff, working at the Cleveland Clinic and acting, as he put it, on the principle that in America everything had to be disposable, wound cellophane tubing around soft drinks cans to build a disposable dialyzer. This was later perfected by Travenol-Baxter as the Twin Coil and used in a steel tank. It had a volume of some ml, expanded as the internal pressure increased, and needed priming with two units of blood before use.

Dialysis in the early days was a complicated affair resembling major surgery, often with teams of doctors and nurses in attendance, blood stained swabs and used syringes everywhere, as well as frequent and unexpected complications. Some units had an adjacent laboratory for two hourly blood determinations to discover if enough urea had been removed.

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Access to the vascular system was obtained by cutting down on the forearm vessels, using tapered plastic cannulae that sometimes were heparinized and left in situ until the next dialysis. Cut downs were also needed for the several double lumen catheters developed at that time, such as that of Piazza in Peru. Then in London in Shaldon adapted the Seldinger percutaneous approach to dialysis by using stiff opaque catheters made in his laboratory.

He at first cannulated both the femoral artery and vein, but later modified his approach by inserting two catheters in the same vein. His introduction of regional heparinisation and his first attempt at overnight home dialysis were also significant advances in that early period. Chronic or maintenance dialysis became practical with the introduction by Scribner and his colleagues of the external arteriovenous shunt. This was made of different sections of Teflon and silastic; at first held together by metal crimp rings and stabilized on the forearm by a metal plate, but later simplified to single tubes of silastic with Teflon tips.

Travenol coil dialyzers, widely used in the s, gradually became smaller, their priming volume reduced from an initial ml to about ml. They were later replaced by the even smaller coil dialyzers of the Extracorporeal Company about 34 and eventually by hollow fiber dialyzers , at first manufactured from modified cellulose and later from more biocompatible synthetic materials. In the s dialysis became increasingly more available owing to government-sponsored programs. The last two decades of the century saw the building of large outpatient dialysis facilities, numerous technical advances, the use of dialysis machines with proportioning pumps, improved monitoring devices, bicarbonate dialysis, better antihypertensive drugs, vitamin D derivatives, parenteral iron compounds, and erythropoietin, and more recently attempts to carry out long nocturnal or short daily dialysis.

There has also been a growing preoccupation with models predicting adequacy of dialysis, often by complex and not necessarily clinically relevant mathematical models. Peritoneal dialysiswas first attempted by Ganter in Germany in Early attempts to carry out chronic dialysis utilized the implanted Barry button and the removable Dean Jacobs prosthesis, but became more realistic with the development of implantable catheters, of which the Tenkhoff catheter has remained the prototype.

Continuous ambulatory peritoneal dialysis and various types of automatic cyclers were the next advance, resulting in a wider application of this technique. The introduction of better systems of dialysis bags and various ways of connecting them to the patients, as well as a better means of treating infection, have resulted in a reduction of the peritonitis rate from 4 to 0.

There have also been advances in the understanding of peritoneal physiology and of how solutes are transferred across the peritoneal membrane. The story of renal transplantation begins in Vienna and Berlin, where in the early s several investigators carried out experimental work and transplanted kidneys from one animal species to another. In the same year he performed the first xenotransplantation—a dog kidney to a goat. He also attempted to implant the kidney of a pig into the elbow of a young uremic woman, but encountered technical difficulties and abandoned the attempt.

Between and Ernst Unger in Berlin carried out further experiments on heterotransplantation, at first in animals, but in he implanted both kidneys of a stillborn human baby into a baboon.

Contributions to Nephrology

The next year he implanted a kidney from a Borneo Macacus monkey into the thigh of a young woman who was deteriorating from renal failure. The kidney produced only a little bloody urine and the patient died soon afterwards. In Lyons, France, Mathieu Jaboulay also made attempts at heterotransplantation in man, using pigs and goats as donors. Alexis Carrel, working in France and later in New York, perfected a method for anastomosing blood vessels and eventually received the Nobel Prize for his work in vascular surgery.

Merrill left explains the workings of an artificial kidney to Richard Herrick middle and his brother Ronald right. The next attempt at transplantation took place in Paris in , by which time techniques of vascular anastomosis and ureter implantation had improved. On December 18, , Jean Hamburger transplanted a kidney from a mother to her child, Marius Renard—a year-old boy who had fallen from a roof and avulsed the pedicle of a solitary kidney. The graft functioned for 22 days before being rejected.

Two years later John P.

Patient Safety in Dialysis Access Contributions to Nephrology, Vol 184

Merrill and Joseph Murray in Boston began a program of live donor transplantation in twins. By they were able to report on seven successful transplants. There were also several attempts at transplanting kidneys from unrelated donors, in Boston and in Paris, using total body irradiation or irradiation of the kidney, but the efforts were plagued by rejection. Success came with the introduction of better immunosuppression, first 6-mercaptopurine and corticosteroids, later the use of azathioprine by Calne Cadaver kidney transplantation, first done at the Hospital Necker in , was soon also carried out by J.

With the discovery of the HLA groups and the introduction of tissue typing, renal transplantation became safer and more successful. Further advances were made during the s and s, leading to the modern era of new and effective immunosuppressive agents such as cyclosporin A, tacrolimus, mycophenolate mofetil, sirolimus, and monoclonal antibodies. Active research is currently being pursued on many fronts: There can be little doubt that in the past renal disease has caused much illness and suffering. It was mostly not recognized as such because diagnostic methods were not available. Many illustrious persons in history are believed to have had kidney disease.

It appears that the Hungarian king Stephan Bathory — and several members of his family had polycystic kidney disease. Then there was Napoleon III, dying in exile in England from uremia consequent to calculous obstructive uropathy. His more illustrious uncle, Napoleon I, also had kidney stones. In recent years two heads of state, Ferdinand Marcos and Yuri Andropov, developed uremia and had dialysis for some time.

To the many other patients dying prematurely of uremia within living memory, the very thought of dialysis or transplantation would have been inconceivable; and now there is every indication that the future will bring about even more spectacular developments. He also serves as Editor-in-Chief of Hektoen International. Franz Volhard left and Theodor Fahr right Glomerulonephritis The seminal observations of Richard Bright and his early successors were followed later by renewed efforts to understand and classify the various forms of glomerulonephritis.

Chronic pyelonephritis Until well into the s chronic pyelonephritis was a popular diagnosis, 11,12 erroneously deemed to be the most common cause of uremia, extensively covered in textbooks and lectures. Renal biopsy Many investigators contributed to the development of this important diagnostic technique. Kark The earliest intentional renal biopsies were done in by Nils Alwall in Lund, Sweden, who biopsied 13 patients but abandoned the procedure after the death of a patient with a single kidney.

Transplantation The story of renal transplantation begins in Vienna and Berlin, where in the early s several investigators carried out experimental work and transplanted kidneys from one animal species to another. Klinische Diagnostik der degenerativen Nierenkrankheiten Ztschr.


The story of nephrology. J R Soc Med ; Novel classification of glomerulonephritis in the monograph of Franz Volhard and Theodor Fahr. Nephrol Dial Transpl ; The Kidney , London , Butterworths, page Nosologic considerations in the nomenclature of acute renal failure. Crush injuries with impairment of renal function BMJ 1: Hemodynamically mediated acute renal failure.

Problems of chronic pyelonephritis. Chronic pyelonephritis at autopsy. Ann Int Med ; Iverson, P and Brun, C. Aspiration biopsy of the kidney. Am J Med ; Cameron, JS and Hicks, J. The introduction of renal biopsy into nephrology from to A paradigm of the forming of nephrology by technology.

Am J Nephrol ; The early introduction of percutaneous renal biopsy in Italy. Technique of percutaneous renal biopsy in the prone position. J Urol ; The nephrotic syndrome in adults: A common disorder with many causes. Explore a collection of highly cited articles from both ndt and ckj.

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Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Volume 33 Issue 12 December Latest articles The effect of maintaining high hemoglobin levels on long-term kidney function in kidney transplant recipients: Reproducibility of the Oxford classification of immunoglobulin A nephropathy, impact of biopsy scoring on treatment allocation and clinical relevance of disagreements: Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients.

Differences in peritoneal dialysis technique survival between patients treated with peritoneal dialysis systems from different companies.