NEPHROLOGY

branch of medicine concerned with the study of kidney functions and the treatment of kidney diseases. The first scientific observations of the kidney were made by Lorenzo Bellini and Marcello Malpighi in the middle of the 17th century, but true physiological understanding of the kidney began with Carl Ludwig's 1844 hypothesis that blood pressure forces waste fluids out of the renal capillaries into the ducts (nephrons) of the kidney. In 1899, Ernest Starling further explained the function of the kidney by proposing that osmotic pressures helped to concentrate the urine there; this theory was confirmed by A.N. Richards in the 1920s. Clinical nephrology, the treatment of kidney diseases, emerged from the disciplines of urology and cardiology as more knowledge was gained about kidney functions. Despite increased information, however, there was little that could be done to treat patients with severe renal (kidney) disease before the 1950s. The first artificial kidney capable of removing blood impurities by hemodialysis was developed during World War II but could be used only for temporary, reversible renal collapse. It was not until Belding Scribner in 1960 demonstrated the usefulness of the permanent Teflon arteriovenous shunt that repeated hemodialysis for chronic renal disease became feasible. Instantly, the outlook for patients with irreversible kidney disease changed from certain death to 90-percent survival. The long-range prospects for these patients was further enhanced by the development of kidney transplants, first successfully performed in 1954 on identical twins; transplants from cadavers, which were more generally applicable, also began in the 1950s.