Emergence of the Concept of Acute Renal Failure

Abstract

Acute renal failure (ARF) is an ailment that has afflicted humans from time immemorial. Its recognition, however, was slow to emerge, hampered initially by the failure to consider it a diagnosis and, subsequently, by the disparity of its nomenclature in the different conditions in which it was observed and described. Further delay was due to the late recognition of the physiology of urine formation and the pathophysiology of acute injury to the kidney, which was to allow the final identification of the entity in the past century. The definition of ‘ischuria’ as the suppression or retention of urine, and its classification to include ‘ischuria renalis’ in the 17th century was a fundamental step that allowed diseases of the kidney to be grouped, studied and described. By the 18th century, the clinical course of ARF was well described, and by the 19th century its microscopic structural features were clearly detailed but continued to be given disparate names by various authors. During World War I, acute failure of kidney function due to trauma was reported as ‘war nephritis’, which with the end of the war became a forgotten entity. In the interval between the two world wars, increased emphasis on experimental studies allowed major advances in the understanding of the hemodynamics of shock, volume homeostasis, kidney function and tubular epithelial cell injury and regeneration. As such, the reports of acute kidney failure in crush victims of the London air raids in 1941 prompted a series of clinical, pathological and experimental studies over the ensuing decade that were to lead to the full emergence of the concept of ARF in 1951.