Nephrology in the United States from Osler to the artificial kidney

Modern knowledge of renal physiology, kidney disease, and the body fluids in American medicine was established largely by Donald D. Van Slyke, Thomas Addis, John P. Peters, Homer W. Smith, and Alfred Newton Richards. Only two of these men were physicians, and through this group future nephrology was shaped by a dominant interest in metabolic problems and pathophysiology. Acute renal failure emerged as a new syndrome during World War II and fostered interest in hemodialysis and renal biopsy. Dialysis, when applied to chronic renal failure, eventually spawned an army of renal clinicians; and biopsy provided a specialist's nosology of what had once enjoyed the unity of "Bright's disease." A society and subspecialty board came late to nephrology and have been directed largely by renal academicians of the metabolic tradition. Nephrology is in the 1980s a bipartite subspecialty, its senior leaders still cherishing the metabolic-physiologic tradition, and a growing army of dialysis practitioners mostly looking after patients with chronic and acute renal failure.