Why a book on kidney disease? A reasonable question once, but no more. From its rather austere, academic origins focusing on renal tubular physiology, the awkward child ‘nephrology’ has now matured into the confi dent adult ‘kidney disease’ of a much greater relevance to the tens of thousands of healthcare workers involved in the complicated and sometimes frustrating business of preventing and curing ill-health.
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Even the word ‘kidney’, so long shunned in favour of ‘renal’ or ‘nephrological’ as a partner for the word ‘disease’, has a new context now – the International Society of Nephrology (well, no one is perfect), the European Renal Association (ditto) and many other organizations have designated the second Thursday in every March as ‘World Kidney Day’. The practice of renal replacement therapy (which describes dialysis and renal transplantation) started in earnest in the 1960s, and in that decade where the star of technological advance burnt so brightly, most of the important technological advances in the provision of dialysis were made.
Initially, dialysis was seen as an acute intervention and as a bridge to renal recovery or to renal transplantation. Signifi – cant numbers of patients started to undergo organ transplantation at around this time, again as the result of technological advances in immunosuppression – the use of steroids and azathioprine. The evolution of the treatment of kidney disorders thereafter has been slower, though far more people are now undergoing long-term dialysis than could ever have been envisaged by the ‘founding fathers’ in both renal medicine and government. The cost of long-term provision of renal support has taxed many healthcare systems, but few so cruelly as the National Health Service, which for decades provided a second-rate service palpably inferior to what was available in Europe and particularly North America (not a unique failing as we can see from international comparisons with cardiac and also cancer services). Under these diffi cult circumstances the fact that kidney medicine and surgery not only survived, but fl ourished in the UK, is a testament to the dedication and zeal of those early pioneers.
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