The contribution of nephrology to the development of current concepts of disease

Historians and philosophers of science rarely comment upon nephrological contributions to the development of general concepts of disease. In the present study, I examine this topic by starting from the premises that an idea of disease pervades most human societies, that received explanations of disease vary between people, societies and eras, and that an understanding of renal disease has often reflected general explanatory trends. Traditionally, most students of disease have belonged to one of four schools: descriptive, causal, mechanistic, or statistical. Descriptivists have tended to focus on manifestations, be these of a symptomatic, a structural, or a functional type. Causationists have focussed upon identification of the origins of diseases. Mechanists have emphasised pathogenetic processes. Statisticians have calculated mathematical differences of parameters from the mean ('the normal'), without explaining the reasons for these. Mechanists currently appear to hold the ascendancy in nephrology through their focus upon the links that connect causes with manifestations. As, however, all schools of thought have historically waxed and waned, I question the wisdom of granting any of them hegemony. Rather, I promote an event idea of disease that encompasses the causal, mechanistic and descriptive schools. Such considerations should assist nephrologists both to treat disease and to identify those of their predecessors who most advanced knowledge.