10 enduring scientific remarks in nephrology
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Two thousand years of Nephrology history:
Ten enduring scientific landmarks
2012.09.27 Kiwon Kim
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About The Selection
By Leon Fine, MD
Vice Dean of Research and Research Graduate EducationChair, Biomedical Sciences in Cedars-Sinai Medical Center
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1. The understanding that the kidneys are the source
of urine
Galen of Pergamum(131-201)
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Galen
Greek doctor, philosopherPhysician of GladiatorsHis anatomy texts were based
primarily on the dissections of pigs and monkeys.
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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
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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
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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
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Marcello Malpighi
A physician. The creator of a medical discipline, Microscopic Anatomy
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Hooke's microscope, employed by Malpighi
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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.
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Hwa C , Aird W C Am J Physiol Heart Circ Physiol 2007;293:H2667-H2679
©2007 by American Physiological Society
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4. The understanding that there are different forms of kidney disease which cause
dysfunction of multiple organ systems
Richard Bright (1789-1858)
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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
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Dropsy: An old term for the swelling of soft tissues due to the accumulation of excess water.
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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)
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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
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6. The understanding that glomerular filtration can be explained on physical principles : Renal physiology emerges as a discipline
Carl Friedrich Wilhelm Ludwig (1816-1895)
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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
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Kymograph 'wave writer'
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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.
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7. The understanding that the kidneys serve to maintain the constancy of the body fluids
Ernest Henry Starling
(1866-1927)
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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.
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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.”
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Starling forces regulating glomerular filtration
Jv= Kf[(Pc – Pi) – (πc – πi)]
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8. The understanding that the kidney function can be determined at a cellular level
Hans H. Ussing (1911-2000)
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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
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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
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Closing Remarks by Dr. Leon Fine