Nephrology

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nephrology

[nə′fräl·ə·jē]
(medicine)
The study of the kidney, including diseases.

Nephrology

 

the branch of internal medicine that studies the etiology, pathogenesis, clinical symptoms, treatment, and prevention of kidney disorders. Diseases studied in nephrology include nephrotic syndrome, amyloidosis, nephropathy of pregnancy, pyelonephritis, and nephritides, such as glomerulonephritis. Nephrology is also concerned with the condition of the kidneys in collagen diseases, in such metabolic diseases as diabetes mellitus and gout, in general infectious diseases, and in systemic circulatory diseases, for example, hemorrhagic vasculitis. Acute vascular insufficiency brought on by traumatic, cardiogenic, or bacteremic shock or by intolerance to medications, serums, and vaccines can result in renal disorders that are also studied in nephrology. An interdisciplinary approach to nephrology is taken that involves clinicians, morphologists, physiologists, radiologists, and other scientists. Nephrology closely borders on the fields on urology and transplantation surgery.

In ancient times, some information about diseases of the kidneys was known to medicine. From 1827 to 1836 the British physician R. Bright, who laid the foundation for studying nephritis and who thus founded the science of nephrology, compared the clinically observed triad—edema, excretion of protein in the urine, and cardiac hypertrophy caused by arterial hypertension—to the characteristic morphological changes of the kidneys and so described many features of the course of nephritis. (Chronic nephritis is also called Bright’s disease.)

Physicians from several countries made fundamental contributions to nephrology. The British scientists W. T. Longcope, A. Ellis, E. G. Janeway, G. W. Pickering, and A. Cashney classified the principal clinical types of nephritides, characterized the kidney changes in arterial hypertension, and described the process of urine formation. The nosology and clinical symptomatology of kidney diseases and the principles of renal insufficiency were studied by the Frenchmen P. Rayer, L. Am-bard, and J. Vidal. The German scientists F. Volhard, T. Fahr, and H. Sarre made clinicopathological comparisons and devised a classification system for nephritides and arterial hypertension. In addition, nephritides and arterial hypertension were investigated by the American scientists E. T. Bell, H. W. Smith, I. H. Page, and J. W. Conn. These Americans were also involved in research on kidney physiology.

Russian scientists have made many contributions to the study of the physiology and pathology of the kidneys. In 1792, A. M. Shumlianskii discovered the cavity known as the Bowman-Shumlianskii capsule in the renal glomerulus. I. M. Sechenov discovered the substantial discharge of venous blood into the inferior vena cava that occurs in accordance with a similar influx of arterial blood into the kidneys. This is the mechanism by which the kidney filters and cleanses the blood. Sechenov also discovered that the microvasculature acts as the “sluice gate” of the blood in the microcirculation of the tissues. S. P. Botkin described a new pathological condition—nephroptosis in healthy young persons who have neurasthenic complaints. In Botkin’s laboratory in 1880, Ia. Ia. Stol’nikov induced cardiac hypertrophy by creating a temporary hypovolemia in the kidneys of an animal. The importance of the diseased renal glomerulus in the genesis of diffuse nephritis was confirmed by M. Bogoliubov in 1862, by N. P. Ivanovskii in 1881, and by D. Dokhman in 1884. In 1853, A. I. Polunin established that severe attacks of the algid stage of cholera are associated with the development of acute renal insufficiency. In I. I. Mechnikov’s laboratory in 1900, V. K. Lindeman first induced immune nephrotoxic nephritis in rabbits; several decades later, this experiment was repeated abroad by many investigators. In 1910, A. F. Kakovskii devised a method for the quantification of elements that precipitate from urine. A test of kidney function that relied on the determination of fluctuations in the specific gravity of the urine was proposed by S. S. Zimnitskii in 1921. In 1924 he proposed a new classification of nephritides. G. F. Lang and A. L. Miasnikov developed a theory that explained the secondary role of the renal link in the neurogenic pathogenesis of hypertensive disease. From 1952 to 1964, A. G. Ginetsinskii provided a more accurate definition of the mechanism of the reabsorption of water in the distal nephron.

The especially significant progress in nephrology that has taken place during the second half of the 20th century has been due to several methodological advances that permit quantification of blood circulation in the kidneys as a whole and of microcirculatory regional disturbances in the kidneys, as well as quantification of the various renal functions. The development of the technique of renal biopsy enables researchers to study the functional and structural aspects, including the dynamics, of the pathological activity in a diseased nephron. Radioisotopic, immunological, biochemical, and genetic methods, as well as angiography and renal biopsy, have all been successfully applied to research in renal pathology.

Renal hemodialysis, kidney transplantation, and new approaches to the dietary treatment of renal insufficiency have led to an important theoretical and practical achievement—the possibility of saving the lives of patients who are in the terminal stages of chronic renal insufficiency or who are suffering from the acute cessation of renal activity.

Nephrology became an independent branch of internal medicine in the 1950’s and 1960’s. Nephrological clinics, kidney-transplant and hemodialysis centers, and nephrological research institutes have been established in the majority of countries. These institutions are headed by leading nephrologists, including J. Amburget and J. Traeger in France; D. A. K. Black and H. E. de Wordener in Great Britain; J. P. Merill in the USA; P. Kincaid-Smith in Australia; T. Orlowski in Poland; C. Dutz in the German Democratic Republic; T. M. Mazhdrakov in Bulgaria; and B. V. Petrovskii, G. M. Solov’ev, A. Ia. Pytel’, N. A. Lopatkin, E. M. Tareev, A. P. Peleshchuk, G. P. Shul’tsev, and G. P. Kulakov in the USSR.

The International Society of Nephrology was formed in 1960, and international congresses on nephrology have been held regularly since that date. Among the journals being published in the field of nephrology are Kidney International (New York, since 1971) and Nephron (Basel, since 1964). The All-Union Scientific Society of Nephrologists was created in the USSR in 1969. Nephrology sections have been established in the local municipal scientific societies of internists and pediatricians in Moscow, Leningrad, and other cities. The journal Urologiia i nephrologiia (Urology and Nephrology) has been published since 1968 (Urologiia was published until 1965).

REFERENCES

Iaroshevskii, A. Ia. Klinicheskaia nefrologiia. Leningrad, 1971.
Osnovy nefrologii, vols. 1–2. Edited by E. M. Tareev. Moscow, 1972.
Fiziologiia pochki. Edited by Iu. V. Natochin. Moscow, 1972.

E. M. TAREEV

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