Identification of kidney disease

Yosuke Hirakawa
The University of Tokyo Hospital

The symptoms of kidney disease are non-specific; therefore, diagnosis of kidney disease without laboratory testing is difficult. This was especially the case in the early 19th century. Surprisingly, the first identification of kidney disease was made by Richard Bright in 1827 before the identification of creatinine and routine measurement of urea. He extensively examined patients with proteinuria, anasarca, and uremia by checking urinary albumin and renal morbid anatomy in his work as a physician at Guy’s Hospital in London (1, 2). Today, some of his cases would be diagnosed as having nephrotic syndrome caused by glomerulonephritis. (3). Identification of what became known as “Bright’s disease” made a huge contribution to medicine. The most important aspect is the distinction Bright made between patients with kidney diseases and patients with cardiac diseases. After this differentiation, the characteristics of kidney disease patients started to be eagerly examined, and it was followed by increased urea and creatinine levels being identified shortly afterwards as major hallmarks of kidney disease.

References

  1. Boss J. Richard Bright’s Reports of Medical Cases (1827): A sesquicentennial note. Bristol Med Chir J. 1978;93:5-6, 18.
  2. Cameron JS. Bright’s Disease Today: The Pathogenesis and Treatment of Glomerulonephritis – I. Br Med J. 1972;4:87-90
  3. Weller RO, Nester B. Histological reassessment of Three Kidneys Originally Described by Richard Bright in 1827-36. Br Med J. 1972 Jun 24;2:761-3.

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