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Chapter 2 - From Bright’s Disease to Chronic Kidney Disease
Book chapter

Chapter 2 - From Bright’s Disease to Chronic Kidney Disease

Steven J. Peitzman
Chronic Renal Disease, pp 7-19
2015
DOI: https://doi.org/10.1016/B978-0-12-411602-3.00002-0
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Barry Brenner Classification Functional diagnosis History Low-protein diets Nomenclature Progression Richard Bright Robert Platt Thomas Addis
In the 1820s and 1830s, Richard Bright of Guy’s Hospital in London showed that dropsy (edema) when associated with heat-coagulable urine (albuminuria) predicted one or another form of pathologically altered kidneys at autopsy. His first cases were of hospitalized patients, but he later recognized and described indolent cases, what we would call chronic disease. Subsequent pathologists created classification schemes for chronic renal disease. In the late 19th century, a movement called “functional diagnosis” turned attention to the kidney’s “power” in health and disease, using tests of excretion and concentration. Here arose terms such as “chronic renal failure” which persisted into the 1990s. The notion of renal “work” led to attempts to “rest” the presumably overworking nephrons of impaired kidneys with the low-protein diet. Key figures were Thomas Addis in the period 1920s–1940s, and Barry Brenner in the later decades of the 20th century. Meanwhile, clinicians identified various causes of chronic kidney disease, only in recent decades including diabetes. Treatment from Bright’s time onward aimed at reducing symptoms, such as edema, until concepts of hyper-filtration and injurious effects of proteinuria prompted therapies (beyond diet) aimed at slowing progression. With a sense that the course of chronic renal disease if identified early might be favorably influenced (particularly by inhibition of the renal-angiotensin-aldosterone axis), nephrologists in the United States and elsewhere through their organizations effected changes in nomenclature (e.g. “kidney” not “renal”) and other measures to de-mystify and raise awareness of kidney disease. The hope was that earlier detection might allow interventions to slow progression and thus avoid or delay the need for renal replacement therapy.

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Web of Science research areas
Primary Health Care
Urology & Nephrology
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