Discovery of the link between kidney disease and hypertension

Dr. Rhys D. R. Evans
Department of Renal Medicine, University College London, UK

Measurement of blood pressure is an integral part of the assessment of a patient with kidney disease due to the recognition of hypertension as a key clinical manifestation of impaired renal function. Richard Bright (1789-1858),provided the earliest descriptions of kidney disease in a series of patients with ‘dropsy’ (oedema) in 18271. The triad of dropsy, albuminuria, and kidney disease became known as “Bright’s Disease”. However, it was another English Physician, Frederick Henry Horatio Akbar Mahomed (1849-1884), who is thought to have been the first to make the link between hypertension and kidney disease. After developing techniques to measure blood pressure as a medical student,in 1874,he published his observations of hypertension being an early clinical feature of acute and chronic kidney (Bright’s) disease2

One of hisearliest observations with the sphygmograph wasthatthepulseofacuteBright'sdiseasecloselyresembles that which had previously been described as occurring in chronic Bright's disease, or, more strictly speaking, with cirrhosis of the kidneyHe found that both conditions were accompanied by a pulse of high tension.

He went on to note: “that previous to the commencement of any kidney change, or to the appearance of albumin in the urine, the first condition observable is high tension in the arterial system”. 

Hence the link between hypertension and kidney disease had been made. 

References

  1. Dr. Bright’s Reports of Medical Cases in Guy’s Hospital. Medico-Chir. Rev.8, 90–103 (1828).
  2. Mahomed, F. A. The Etiology of Bright’s Disease and the Prealbuminuric Stage. Medico-Chir. Trans.57, 197–228 (1874).

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