Renal Institutions

UK History

Renal Association

The UK's Renal Association was founded in 1950; the second society of nephrologists. Its first president was Arthur Osman. Its first meeting was on 30th March 1950 in London

If you are a UK-based renal health professional, this is an important document to read: 'History of Dialysis in the UK: c1950-1980' (Wellcome Witnesses to Twentieth Centrury Medicine, Volume 37). It is a Witness Seminar Transcript of a meeting, held on 26.2.2008, at the Wellcome Trust.The history of the Renal Association has been written by Professor Stewart Cameron in two parts: A and B. Stewart Cameron is the only UK nephrologist to have been the President of the Renal Association (1992-5), ERA-EDTA (1984-87) and ISN (1993-5)

British Transplant Society (BTS)

The late John Hopewell, transplant surgeon, founded the British Transplant Society (BTS) with Leslie Brent in 1972, has written a memoir on the BTS site, and runs a website (Renhist) describing the history of various units in the UK. Some information from the The 'Early History' on this website was used in this website and is worth reading. He has also reviewed and contributed to the above timeline, for which we are grateful. Thomas Starzl, wrote a good history of the early years of transplantation in 2011. Stewart Cameron's book A History of the Treatment of Renal Failure by Dialysis was another important source of information

Development of Renal Information Technology in the UK

Renal Units in the UK were quick to exploit the possibilities of information technology (IT) development in the 1980s. Why? The predominance of numerical data, combined with few, repeated, and complicated treatments (and the serial management of patients) were tailor-made for IT solutions. Initially the focus was on computation (prediction of patient numbers or transplant rejection, calculation of glomerular filtration rate (GFR) from serum creatinine and assessment of dialysis dose, etc.); as much as on retrievable data storage and presentation. The development of PROTON (the UK’s first renal database) at Charing Cross Hospital by Hugh de Wardener, and its commercialisation through Clinical Computing Ltd (CCL), boosted the everyday clinical potential of computing. This was first taken up by Robert Sells (Transplant Surgeon, Liverpool) and Martin Knapp (Nephrologist, Nottingham) after 1979. 

In 1982, at the instigation of Molly McGeown (Belfast, President, Renal Association 1983-6), Neville Selwood (UK Transplant Service, now NHS Blood and Transplant) and Roberts Sells, a British Renal Computing Group (BRCG) was established, to encourage the coherent development of renal computing in the UK. Es Will (Leeds, St James’s) was co-opted as Chairman. He organised with others an annual national meeting for the exchange of information, presentations and invited speakers. The BRCG introduced wider discussion of dialysis dose (Kt/V) through Frank Gotch (San Francisco, USA) and its routine calculation within PROTON at some sites.

The group also increased awareness of Expert Systems and Bayes Theorem, explained the Data Protection Act 1984 and investigated the contribution of computer support staff. The considerable effort of annual (paper-based) unit reporting of each patient on renal replacement therapy to the ERA-EDTA Registry was addressed by disc transfer or modem transmission; from (ultimately) two dozen, largely regional, UK renal unit databases to St Thomas’ Hospital (Tony Wing, Chairman, EDTA Registry). This mainly involved the completion of data fields and a treatment ‘Timeline’ rather than serial numerical laboratory data. It allowed piecemeal registration of data at unit level through the year rather than an unsustainable year-end blitz. It was also possible to use an electronic ‘backfill’ from EDTA records to populate start-up databases in new systems.

The BRCG operated from 1983 to 1988. It ran in parallel with a variably active CCL User Group. These early exercises prepared the nephrological community for the development of the UK Renal Registry in 1995. In retrospect, before an electronic registry for UK patients with renal failure could be considered , it was necessary for units to develop electronic databases; hence PROTON was essential, and became the basic building block for the UK Renal Registry. In addition to traditional epidemiological information, the Audit and Evidence-based Medicine (EBM) cultures (first Renal Standards document in 1995, led by Stewart Cameron, Guy’s), had by then, shifted interest towards numerical calibration of patients. This was facilitated by extensive downloading of laboratory data and more sophisticated graphical presentation of statistical data.

Based on a slowly increasing number of units that used such databases, the UK's Renal Registry was first established in April 1995 as a 2-year pilot project (of six units) and produced its 'first annual report' (of the pilot) in March 1997. The six were units: Birmingham (Heartlands), Gloucester (Gloucester Royal Infirmary), Leeds (St James's University Hospital), Leicester (Leicester General Hospital), Plymouth (Derriford Hospital) and Sheffield (Northern General Hospital). The data from Gloucester and Plymouth may have not been incorporated as they may have been incomplete. This report was not widely available. Nine units subsequently contributed data to the first (non-pilot) report:

  • Birmingham (Heartlands Hospital)

  • Bristol (Richard Bright Renal Unit, Southmead Hospital)

  • Gloucester (Gloucester Royal Infirmary)

  • Leeds (St James's University Hospital, excluding Leeds General Infirmary)

  • Leicester (Leicester General Hospital)

  • Plymouth (Derriford Hospital)

  • Middlesborough (South Cleveland Hospital)

  • Nottngham (Nottingham City Hospital)

  • Sheffield (Northern General Hospital)

The first non-pilot report (actually the second but known as the first) was produced in September 1998.

All the reports are available on the Registry's website. The registry was instigated by Sir Netar Mallick (Manchester, President, Renal Association 1989-92). He asked Terry Feest (Bristol) to head it up; and together they worked hard from around 1992 to get it established. When adequate 'buy in' and funding were established, David Ansell started to run day to day business in 1995. David Ansell initially worked part-time but later full time, leaving in 2010.

Other important people were Colin Brown, as Secretary (1992-96), who worked with Netar Mallick and Terry Feest to get support and funding; and Es Will as Secretary (1996-2008). Paul Roderick provided public health and epidemiological advice and support to the registry from its early days. Other renal units progressively either became converted to the idea – or obtained software that would enable them to join the Registry. Full coverage in the UK was achieved in 2007, with full electronic coverage achieved in 2008.

The UK Renal Registry was not anticipated to take on the wider issues of renal IT development. So, in 2003, John Feehally (Leicester, President, Renal Association 2004-7) convened a Renal Information Exchange Group (RIXG). This was multi-disciplinary, with representatives from a range of organisations involved in national renal affairs, as well as regional clinical delegates. The backdrop was the development of the Renal National Service Framework (2001-4/5), which contained a dedicated IT component. One consequence was a national audit of renal IT and subsequently the initiative to permit patients secure access to live renal databases, Renal Patient View, 2004-5.


International History

'Societe de Pathologie Renale'

The world's first society of nephrology was the French 'Societe de Pathologie Renale'. Its first president was Jean Hamburger, and its first meeting was in Paris in February 1949. In 1959, Hamburger also founded the 'Société de Néphrologie', as a continuation of the older society

The Società di Nefrologia Italiana was founded in 1957 and was the first national society to incorporate the phrase nephrologia (or nephrology) into its name

International Society of Nephrology (ISN)

The word 'nephrology' appeared for the first time in a conference, on 1st-4th September 1960 at the "Premier Congrès International de Néphrologie" in Evian and Geneva, the first meeting of the ISN. The first day (1.9.60) was in Geneva and the next three (2-4.9.60) were in Evian, France. The early history of the ISN is described by Robinson and Richet (2005) and the later history by Barsoum (2011)

Stewart Cameron has also published a 7 volume bibliography of the history of nephrology for the ISN. Also working for the ISN, Stewart Cameron and Kim Solez lead a video legacy project, with transcripts of interviews with 42 pioneering nephrologists

European Renal Association - European Dialysis and Transplant
Association (ERA-EDTA)

The idea to form a European Association for dialysis was conceived during an international symposium on acute renal failure organised by Stanley Shaldon at the Royal Free Hospital on 2nd September 1963. After the symposium, David Kerr suggested to Stanley that there should be an annual symposium on dialysis, drawing together nephrologists in Europe

Stanley said that William Drukker, whom he had met the previous year at a meeting of the West European Clinical Chemistry Society, had made a similar suggestion. Stanley arranged for the three to meet after the closing dinner in the Apothecaries’ Hall. They agreed to test the enthusiasm for the idea among nephrologists in Western Europe by inviting them to join in creating a society to run these annual events. They suggested the title “West European Dialysis Association” (WEDA), which would later become the ERA-EDTA

A council was elected and William Drukker appointed the first Secretary-Treasurer and David Kerr the first Editor of the Proceedings. For the first 9 years of EDTA, papers were presented and published in French as well as English so Daniel Fries and Jules Traeger became French co-editors

On Thursday 24 September 1964, the Gang of Three (Shaldon, Keer and Drukker) and 210 delegates from 16 different countries convened at a founding meeting held at the Queen Wilhelmina Hospital of the University of Amsterdam. An association was created, called the ‘West European Dialysis Association (WEDA)’

This first congress was a great success with guest lectures from Willem Kolff, returning for the first time to his homeland where he pioneered haemodialysis, and from Sergio Giovannetti on dietary control of uraemia and 52 presentations from Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Netherlands, Sweden, USA and UK. On its twentieth anniversary, EDTA recognised the need to widen its remit to include all of nephrology and changed its name to EDTA-ERA. The history of the EDTA has been described by Jorge B Cannata-Andía in 2008

Regarding the name EDTA, Stanley Shaldon has written;

"I think one of the most interesting anecdote concerning ERA-EDTA relates to the naming of the Society. Drukker, Kerr and I thought after our meeting at the Royal Free hospital that we should start a West European Society of Dialysis namely WEDA. The French led by Hamburger were against this and considered it a 'Nato plot'

Hamburger entertained us to a fantastic dinner in Paris and we agreed, after a lot of discussion, to change the name to EDTA which was the acronym for a compound used in the treatment of lead poisoning (Ethylene Diamine Tetra_Acetic Acid). Hamburger was not happy as he objected to the 'T'. However we decided to go ahead and in a compromise with Hamburger we agree to make the society bilingual (English and French). It remained so for a few years

The English were not happy with this French dominance as they already had a Society called the Renal Association and objected strongly to the name. Consequently to pacify them the name was then modified from EDTA to EDTA-ERA and finally later to ERA-EDTA. But curiously enough in common parlance it remains EDTA as the acronym is usable in all European languages without difficulty and I believe was my suggestion"

He also said in 2003: “The recent suggestion that EDTA be dropped from the name seems unreasonable in that both froma historical point of view (as the oldest of the Dialysis and Transplant Societies), and from an interest of membership viewpoint by abstract submissions, dialysis is certainly a major interest of the Society. The pejorative connotation associated with the use of the term dialysis should not be allowed to influence the decision to change the name of the association”

American Society for the Artificial Internal Organs (ASAIO)

The first meeting of the American Society for Artificial Internal Organs was held in 1955, at the Hotel Chelsea in Atlantic City, New Jersey with 67 founding members

American Society of Nephrology (ASN)

The American Society of Nephrology (ASN) was founded in 1966. Its first president was Neal S Bricker. The first annual meeting of ASN was in Los Angeles, on 18-19th October, 1967

The Mother or Father of Nephrology

We think that is is impossible to state who is the father or mother of nephrology. Many could claim that title. In the timeline on this website, twelve pioneers are mentioned twice, ie were responsible for 2 landmarks achievements: Thomas Addis (Edinburgh then Stamford USA), Roy Calne (Cambridge), Jo Eschbach (Seattle), Willard E Goodwin (UCLA), Thomas Graham (Glasgow), John Hopewell (London), Jo Joekes (London), David Kerr (Newcastle), Netar Mallick (Manchester), Peter Medawar (UK), John Merrill (Boston), Russell Palmer (Vancouver) and Richard Stewart (Michigan). Rene Kuss (Paris), Wayne Quinton, Belding Scribner (Seattle) and Stanley Shaldon are the only pioneers with three landmarks. Nils Alwall (Lund, Sweden), Jean Hamburger (Paris), Wilhem Kolff (Kampen, Netherlands) and Gordon Murray (Toronto) are the only pioneers with four achievements

Though only getting one mention in this website's timeline, one nephrologist stands out. Pierre-Francois Olive Rayer (Paris), has a staggering list of achievements. He first described renal vein thrombosis, renal anaemia, and a classification system that distinguished acute nephritis, nephrotic syndrome and pyelonephritis; and introduced urine microscopy into medical practice. Thomas Addis has two mentions on the timeline but the importance of his work cannot be overstated. He published (with Jean Oliver) his classic 'The Renal Lesions in Bright's Disease'. He was first to standardise the technique for the quantitaive examination of the urinary sediment - the Addis Count; and described the urine/plasma urea ratio, a direct precursor to the urea clearance concept, as conceptualised by George Barnett in 1920

There have been two Nobel prizes awarded for achievements related to nephrology and transplantation: Alexis Carrel (Lyon, France then New York) in 1912 and Joseph Murray (Boston) in 1990

Nothing is new. Hippocrates (ca 460-370 BC) made over 30 observations relevant to nephrology