Dropsy, Dialysis, Transplant: A Short History of Failing Kidneys (review)

Historical reviews of medicine, medical discoveries, illness, and its treatment rarely extends over a period of more than one hundred years. In the case of renal disease and the symptoms of dropsy, it was Richard Bright’s publication in 1827 involving the “Kidney in Dropsy” that recognized the renal origin of the disease and its production of albuminuria. Peitzman carefully and in detail describes the early years of Bright’s Disease and its relation to the clinical symptoms. The pathologic description of Bright’s Disease by Virchow emphasized cellular pathology, the role of the microscope, and the description of various types of renal disease. Peitzman describes the emphasis of microscopic examination of the kidney with three developments: (1) improvement of optics, (2) the discovery of the cell theory, and (3) methods of cell staining as a means to distinguish various cells. In the early years after Bright’s description in 1827 the description of the disease process included dropsy, pericardial rub, albuminuria, and recognition that the disease may proceed to kidney failure and death over a period of weeks, months, or years differentiating the acute form of the disease from the chronic. In the mid-1800s microscopic examination of the urine revealed tubular casts formed in renal tubules and were separated into red cell casts, white cell casts, hyaline casts, and granular casts representing renal disease. The cellular observations of Bright’s Disease was combined with the assessment of renal function. Peitzman describes the role of Thomas Addis and his publication with Jean Oliver of The Renal Lesion in Bright’s Disease (New York: Paul Hoeber, 1931) and the clinical application of the Addis count as a means to quantify the progression of Bright’s Disease. This was combined with blood and urea concentration as a ratio which later was simplified to blood or serum creatinine. The serum creatinine remains a reliable and simple test of renal function.

Kolff during World War II designed a crude but in some circumstances effective homemade dialysis machine utilized successfully in a few patients with acute renal failure. Simultaneously in Britain reports of renal failure occurred in patients with crush injuries classified as myoglobinuric renal failure (Bywaters and Beall). Colonel Lucke of U.S. Army of Pathology described the pathology in these patients as ‘lower nephron nephrosis.” These pathologic entities were later referred to as acute tubular necrosis or ATN and now called acute kidney injury, AKI, and both terms continue interchangeably today.

The utilization of dialysis for acute and chronic renal failure became important in the treatment of renal failure and of special value in patients with acute renal failure who may recover with temporary dialysis support. Acute hemodialysis utilized in the Korean conflict in the early 1950s was of special value in sustaining injured soldiers until renal function returned—often resulting in a normal life thereafter.

This well written book continues with the treatment of chronic renal failure by both long-term dialysis and/or transplantation. The author recognizes the limitations of long-term dialysis, the complications of metabolic bone disease, and the long hours on the machine often with painful muscle cramps near the end of treatments. The only means for the patient to escape dialysis is by death or renal transplantation with the latter choice by far the best. Unfortunately, for those patients waiting for the telephone call for a cadaveric kidney may be several years or more since the cadaveric waiting list far exceeds the number of donors leaving some patients waiting forever. The shortage of cadaveric organ donors is a national and world wide problem that may never be resolved unless xeno-grafts become a clinical reality most likely years away.

This readable and enjoyable book by Peitzman covers more than 180 years and is of interest to physicians and surgeons alike as well as to medical students. In some ways it is a companion to F. D. Moore’s book, Give and Take: The Development of Tissue Transplantation...