1. Two thousand years of
Nephrology history:
Ten enduring scientific
landmarks
2012.09.27
Kiwon Kim

2. About The Selection
By Leon Fine, MD
Vice Dean of Research and Research
Graduate Education
Chair, Biomedical Sciences
in Cedars-Sinai Medical Center

3. 1. The understanding that the
kidneys are the source of urine
Galen of Pergamum(131-201)

4. Galen
Greek doctor, philosopher
Physician of Gladiators
His anatomy texts were based
primarily on the dissections of
pigs and monkeys.

6. 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

7. 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

10. 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

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

12. Hooke's microscope, employed by Malpighi

13. 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.

15. Hwa C , Aird W C Am J Physiol Heart Circ Physiol
2007;293:H2667-H2679
©2007 by American Physiological Society

17. 4. The understanding that there are different
forms of kidney disease which cause
dysfunction of multiple organ systems
Richard Bright (1789-1858)

18. 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

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

23. 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)

24. William Bowman
 He 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

26. 6. The understanding that glomerular filtration
can be explained on physical principles :
Renal physiology emerges as a discipline
Carl Friedrich Wilhelm Ludwig
(1816-1895)

27. 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

28. Kymograph 'wave writer'

29. 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.

30. 7. The understanding that the kidneys serve to
maintain the constancy of the body fluids
Ernest Henry Starling
(1866-1927)

31. 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.

32. 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.”

33. Starling forces regulating glomerular filtration
Jv= Kf[(Pc – Pi) – (πc – πi)]

34. 8. The understanding that the kidney function
can be determined at a cellular level
Hans H. Ussing (1911-2000)

37. 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

42. 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

46. Closing Remarks by Dr. Leon Fine