Budapest nephrology school - 30 years of history - from modest start to an international success: systematic summary of the 27th BNS held between 28th August and 2nd of September 2023.

Budapest Nephrology School (BNS) could have celebrated its 30th event if it had not been interrupted by COVID pandemic for a few years. Yet, the organization of 27th BNS in August 2023 resumed its successful and traditional activities at Semmelweis University, in the beautiful central European city of Budapest. In over two decades, BNS has faithfully adapted to the changes and developments of medical science and clinical nephrology, the fact which has kept it unique and attractive for nephrologists from across the globe. With such a long history and representing the top international professors of nephrology, BNS has proved to be a successful one-week, in-person refreshing course which has attracted over 1600 medical doctors from more than 60 countries. It has well served as an academic meeting point suitable for networking and exchange of up-to-date knowledge presented by the best international experts in nephrology. The dedication and focus of these experts on education, research and patient care represent the very concept of translational medicine. The invaluable experience of the past 27 years has set the standards for BNS to contribute to the evolution of translational nephrology in Europe in the next decade.

The history of peritoneal dialysis in China: past, present and future trends.

Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of patients on PD. In this manuscript a brief review of the history of peritoneal dialysis in China is presented; this includes a description of pioneers and their important contributions, discussion of peritoneal dialysate, the technique of the use of Tenckhoff catheter, the use of continuous ambulatory peritoneal dialysis (CAPD) and dialysis registration. Current ongoing PD research activities among Chinese PD academicians are also discussed. Finally, we present four areas of future focus: 1) the promotion of PD in rural areas where PD use is still very limited due to the lack of PD awareness and education; 2) PD quality management and continuous quality improvement (CQI) program particularly focusing on PD adequacy and patient rehabilitation; 3) development and enforcement of national standards on PD management; 4) multi-center studies to compare the benefits of PD and hemodialysis (HD) that should include survival, rehabilitation and cost-effectiveness.

A short cultural history of the UK Renal Registry 1995-2020.

The Renal Association UK Renal Registry (UKRR), established in 1995, has reflected the development of Nephrology within the NHS over 25 years. It has been gradually enlarged to provide a formal agency for a range of consensus initiatives. It remains the source of the national epidemiology of renal replacement, feeding NHS infrastructures and Health Services Research. An extension into acute and chronic kidney disorders is in hand. As a template for medical audit it has contributed to a quality improvement ethos derived from several methodologies. It now offers a multifaceted virtual platform for special interest groups and patient-centricity. Its transformation demonstrates one of the compromises that have permitted specialty development within the inconstant envelope of the NHS.If not always a bellwether, the clarity, form and scale of kidney disease provision still qualifies the UKRR as a demonstrator of healthcare possibilities to Medicine, Clinical Informatics and the NHS.

IgA nephropathy: "State of the art": a report from the 15th International Symposium on IgA Nephropathy celebrating the 50th anniversary of its first description.

On September 27-29, 2018, the International Symposium on IgA Nephropathy, organized by the International IgA Nephropathy Network, was held in Buenos Aires, Argentina, celebrating the 50th anniversary of the first description of IgA nephropathy by Berger and Hinglais in 1968. The meeting was attended by over 200 scientists and clinicians from 26 different countries across the globe. We report some key insights drawn from the meeting-including the molecular pathogenesis, genetics, pathology, and therapeutics of IgA nephropathy.

Gabriel Richet: when medicine combines with courage.

Gabriel Richet, one of the fathers of the French and international Nephrology, was a man remarkable for his courage, vision and empathy. He was proud and brave, and he presented himself proud of being brave. He opens his interview speaking about his youth, when he was injured, and went back to the fight. He cites the number of stitches he received, but doesn't cite being decorated with the Légion d'Honneur, one of the highest honours of the French Republic. This anecdote perfectly illustrates his elegance and detachment from awards and self-satisfaction. Gabriel Richet was a visionary. He was the first one to use the artificial kidney in France. Together with Jean Hamburger and Jean Crosnier at the Necker hospital, he developed the concept of renal intensive care and, later on, he was one of the first to develop the concept of translational nephrology.At a time when medical writing was not acknowledged, he authored almost 400 manuscripts indexed on Medline. He was over 90 when his last papers, dealing with the history of Nephrology, were published, some of them as sole author.In the interview, as well as in his life, he did not renounce to a provocative self-irony. A physician should never give up, he should assume the full responsibility of his actions, and practice medicine with the heart: "I am like the Queen of Holland, whose motto is: I will maintain". In our uncertain, unsafe, fragile and turbulent world, there is no better motto for us all.

The Pioneers of Nephrology - Professor Gabriel Richet: "I will maintain".

Gabriel Richet was one of the great pioneers of European Nephrology. After a pivotal period of work with Jean Hamburger, whom we owe the name of our discipline, Nephrology, he contributed to all aspects of this specialty and was, in particular, a forerunner in dialysis and in the study of interstitial nephropathies.In this passionate and lucid interview, recorded in Paris in 2010, he describes himself as a "lucky man", able to transform folly in happiness. He does not describe himself as an intellectual, but as a warrior, and closes a detailed history of the early days of European Nephrology with a strong statement of the moral stature a physician should have: he underlines, in line with his strong personality, that a physician is a man able to decide, to give orders and to assume their consequences. However, science and care of human beings cannot exist without a heart. "A doctor is someone who decides; when he writes a prescription, this means he prescribes and takes responsibility. Is it possible to give a prescription and decide regardless of compassion?". In his interview, he commented that this last statement is probably not uniformly agreed, but that he'll always defend it, adds freedom as a moral value that a physician should proudly defend: "Unfortunately I know that many do not share my idea, but that's life... I am like the Queen of Holland, whose motto is: I will maintain!".

Nephrology: As It Was Then, But Is Not Now.

Diseases of the kidney are old, but the discipline dedicated to their study, nephrology, is barely more than 50 years old. As recounted in this recollection of those events, the rudiments of what would become nephrology emerged in the time between the 2 World Wars from basic studies of normal kidney function and flourished after the integration of their methodologies into clinical medicine thereafter. Although shaped by studies of kidney function in the 1960s, it was the subsequent advent of dialysis that fueled the growth of nephrology well into the 21st century. Although to some extent this growth was a product of technical developments (micropuncture, dialysis, biopsy, etc), it was the paradigm shifts they engendered that brought about the revolutionary changes that stimulated the growth of nephrology from its formative years in the 1960s. Notable among those was the classification of chronic kidney disease on the basis of kidney function, calculated from serum creatinine level as estimated glomerular filtration rate, that has expanded nephrology's interaction with and integration into other disciplines and begat the recent outpouring of epidemiologic and interventional studies, thereby establishing it as a leading discipline dedicated to improving outcomes for individuals with kidney disease worldwide.

Pediatric kidney transplantation: a historical review.

Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation (vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.

PART 2. NEPHROLOGY SOCIAL WORK: LOOKING BACK, LOOKING FORWARD.

The field of nephrology social work has undergone considerable change since the release of the 1976 federal regulations requiring a master's level social worker to be part of the renal team. Moderated by veteran nephrology social worker Stephanie Johnstone, LCSW, those who have served patients in the front lines of kidney care speak here about the past-"What has nephrology social work contributed in the last three decades, and what it has struggled to accomplish?" - and about the future: "How can nephrology social workers best serve patients in the years ahead? Where is their greatest potential to advance the industry?" Ms. Johnstone, an NN&I Editorial Advisory Board member, has worked for Fresenius Kidney Care for over 33 years. She is currently the Field Support Liaison, Clinical Innovations Team and Lead Social Worker, So Cal Region for FKC, and is based in San Diego.

Beginnings-The Kidney and Nephrology in Ancient Mesopotamian Culture.

A defining period in the history of civilization occurred in ancient Mesopotamia. While some of Mesopotamian contributions to knowledge (writing, mathematics, astronomy) have been recognized, those made to medicine are just beginning to be studied and appreciated. The medicine of the time developed in a theocratic society where local gods controlled all aspects of life and their healers were learned scribes who established the priestly medicine of old. For their use of prayers and incantations as a component of therapy Mesopotamian medicine has been belittled and relegated to magic. In fact, the Mesopotamian healers established the basic medical skills of observation, diagnosis, prognosis and treatment and, over time, systematically produced an expanding corpus of medical knowledge that had not existed theretofore. The kidney as an organ, the components of the urogenital tract, some signs and symptoms of renal diseases, and the art of urinalysis were first conceptualized, studied, and codified in Mesopotamia. In doing so, the Mesopotamians set the foundations of rational medicine that would follow after the introduction of the phonetic alphabet and the Socratic method of questioning and debate to stimulate critical analysis.

The Evolution of Critical Care Nephrology in Edmonton.

The University of Alberta (UofA) in Edmonton, Canada has a rich and productive history supporting the development of critical care medicine, nephrology and the evolving subspecialty of critical care nephrology. The first hemodialysis program for patients with chronic renal failure in Canada was developed at the University of Alberta Hospital. The UofA is also recognized for its early pioneering work on the diagnosis, etiology and outcomes associated with acute kidney injury (AKI), the development of a diagnostic scheme renal allograft rejection (Banff classification), and contributions to the Renal Disaster Relief Task Force. Edmonton was one of the first centers in Canada to provide continuous renal replacement therapy. This has grown into a comprehensive clinical, educational and research center for critical care nephrology. Critical care medicine in Edmonton now leads and participates in numerous critical care nephrology initiatives dedicated to AKI, renal replacement therapy, renal support in solid organ transplantation, and extracorporeal blood purification. Critical care medicine in Edmonton is recognized across Canada and across the globe as a leading center of excellence in critical care nephrology, as an epicenter for research innovation and for training a new generation of clinicians with critical care nephrology expertise.

A forgotten chapter in the history of the renal circulation: the Josep Trueta and Homer Smith intellectual conflict.

This article reviews the pioneering and visionary contributions of the Catalan surgeon Josep Trueta (1897­1977) to the changes in renal circulation that contribute to the pathogenesis of acute renal failure (ARF). An erudite scientist with eclectic interests in physiology, orthopedics, politics, and medical history, Trueta's initial involvement in wound healing as a trauma surgeon during the Spanish Civil War and the London Blitz is what prompted him to postulate that a trauma-induced "neural effect" on the renal vasculature, with resultant renal arterial constriction could cause ARF. To test his hypothesis, Trueta assembled an experienced radiologist, a renowned physiologist, and a renal pathologist to study ARF in Oxford. They investigated the renal circulation of rabbits in response to diverse traumatic conditions by injecting a radio-opaque substance, using cine-radiography to visualize the flow of blood through the renal vasculature. Trueta's suggestion of renal cortical ischemia and diversion of blood to the less resistant medullary circulation (Trueta shunt) was criticized by Homer Smith and coworkers. In contrast to Homer Smith's data, which were derived from clearance studies and renal arteriovenous oxygen, Trueta used the diametrical opposite method of "direct" observation of the renal circulation. Their differing methodologies, direct visualization of the renal circulation as opposed to inferred computations from clearance studies, accounts for some of their conflicting theories. Nevertheless, the proposal of disparate renal flow compartments focused attention on intrarenal hemodynamics. Trueta's focus on renal cortical ischemia was ultimately validated by the studies of Barger in the dog and Hollenberg and Epstein in human subjects.

The Scientific Revolution--The Kidney and Nephrology in and about the Seventeenth Century (Part 1).

In the history of the evolution of the medical sciences, it is in the 17th century that the conscious, deliberate, and systematic study of the workings of the human body began. It was a product of the radical changing attitudes of this insurgent century when mathematical reasoning and mechanistic philosophy replaced the teleological outlook of earlier times. It was then that meticulous observation, reproducible quantification, experimental validation, and mathematical exactitude in the quest for truths launched the Scientific Revolution. The effect on medicine was a transformative change from a descriptive to an explanatory body of knowledge during the course of which rigorous anatomical dissections were used for the mechanical explanation of organ function, when morbid changes observed at postmortem began to be related to clinical features of disease, and when the secretive analytical methods of alchemy began to be refined for the study of chemical changes in living matter. Essentially what began with meticulous observations of anatomical features begat physiology and laid the foundations of pathology and chemistry. As a result, studies of organ structure, function, and changes in disease in general, and of the kidney in particular, were clarified and progressed at a rate never achieved theretofore.