The Development of Pediatric Nephrology

Abstract

The following is the first article in this series. It Pediatric nephrology, as a discipline, arose from descriptive studies of childhood glomerulonephritis in Europe and the field of pediatric metabolism in the United States. While pediatric scientists before 1950 were concerned with fluid and electrolyte metabolism, regulation of intracellular and extracellular fluid, acid-base homeostasis, and parenteral fluid therapy, the defined field of nephrology developed after the Second World War around six major advances: ACTH and glucocorticoid therapy for nephrotic syndrome; renal biopsy to diagnose glomerular disease; the role of immunologic factors in glomerular injury; the use of dialysis as renal replacement therapy; renal transplantation as the optimal form of therapy in children with end stage renal failure; and recognition of renal disease in the etiology of 80% of cases of childhood hypertension. These discoveries led to focused research, the definition of specific training in nephrology, establishment of an American, European, and an International Society of Pediatric Nephrology, as well as an American SubBoard of Pediatric Nephrology, and the inception of a journal, Pediatric Nephrology, now in its 15th year. Major research themes have included developmental nephrology, transplantation immunology, and concerns about growth in children with renal disease. Many clinical entities have been described in detail, some of which are almost confined to children. The scientific basis of pediatric nephrology, ongoing patient care needs, and its technical aspects -renal biopsy, dialysis and transplantationassure its continuing future as a major pediatric discipline on all continents. (Pediatr Res 52: 770-778, 2002) I. THE ORIGINS OF INTEREST IN CHILDHOOD RENAL DISEASES: 1820 -1950The development of the discipline of pediatric nephrology arose from clinical research conducted in the 130-year period from 1820 to 1950. It was during this period that pediatric scientists became interested in the definition of glomerular disorders and in fluid and electrolyte metabolism, the maintenance of normal volume and tonicity and acid-base status, as well as the pathophysiology of such disorders as rickets and diarrhea (1-5) ( Table 1).Pediatric kidney disease was initially considered from a descriptive rather than quantitative perspective. Early treatises on kidney diseases in children were remarkably accurate in terms of their clinical descriptions of various renal disorders, particularly glomerular conditions. In the 11th edition of Eduard Henoch's classic text Kinderkrankheiten (6), he describes

Are oxidized low-density lipoprotein and C-reactive protein markers of atherosclerosis in nephrotic children?

“…The examination was performed on a group of 23 children and adolescents diagnosed with INS according to the definition of the International Society of Kidney Disease in Children [ 15 ], treated in the Department of Pediatrics and Nephrology, in years 2011–2012. All nephrotic patients who fulfilled the inclusion criteria were included in the study.…”

Preserving oral history: 50 years of paediatric nephrology in Europe

“…Several written accounts of the histories of paediatric nephrology have been collated from different geographical viewpoints, mainly about the organisations that were set up to collaborate innovations across the UK,3 Europe4 and internationally 5. The Wellcome History of Twentieth Century Medicine held a witness seminar about dialysis in the UK 1950–1980 that included accounts from pioneer doctors, nurses and patients that included a child and her mother 6…”

Pediatric Renal Replacement Therapy in the Intensive Care Unit

“…The first reports of pediatric renal replacement therapy (RRT) occurred in 1961 with the use of peritoneal dialysis (PD) for infants and children [1]. PD remains the primary form of long-term RRT for children with end-stage renal disease [2, 3], and continues to be used to support children with acute kidney injury (AKI).…”