Michael Boulton Jones (MBJ) joined Glasgow Royal Infirmary as consultant in May 1975, from being senior registrar to Keith Peters at Hammersmith Hospital. Read also his personal commentary on Hammersmith. When Prof Arthur Kennedy retired in 1988 he was appointed consultant in charge of the unit.
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I was only the second consultant in the Renal Unit, with Arthur Kennedy, but there were as many as five senior registrars/lecturers as well as a registrar and rotating residents. The unit was part of the Department of Medicine. Tenovus Scotland had funded an investigation unit of seven beds available five days per week and a small laboratory. An acute unit in the basement of the Department of Urology had five beds. The 12-station dialysis unit was in a prefab building in the car park near the Dept of Urology. I guess that was a fairly typical arrangement for a new specialty shoehorned into a hospital already functioning at full capacity. For the same reason perhaps, but maybe also because urologists were involved in dialysis in other centres, the urological registrar was responsible for vascular access and, when CAPD was introduced, for insertion of Tenckhoff catheters. It took sometime to persuade vascular and abdominal surgeons to take on the task but the improvement in quality was gratifying.
The renal services of the West of Scotland had already been divided between GRI, the Western Infirmary where Douglas Briggs had started a Transplant Unit, and Stobhill Hospital where Alistair McDougal had set up a Home Haemodialysis Unit. These three provided the renal services for the West of Scotland, some 2.7 million people spread over a vast area from Dumfries to Oban.
Over the years, the dialysis unit and the acute unit were moved into adjoining wards, and the five-day investigation ward was amalgamated with the acute ward. The renal units of Stobhill and the Royal merged in the 1990s to help manage the on call rotas. I helped set up a hospital haemodialysis service in Falkirk, where we also ran a weekly out-patient clinic. After my retiral, the three Glasgow units were all united in the new giant hospital (Queen Elizabeth University Hospital) which opened in 2015.
Glomerulonephritis and diabetic nephropathy became the focus of our clinical and research activities. I founded the GN clinic in 1975 and documented patients as they passed through. This resulted in various longitudinal studies and papers. Animal studies in rats revealed that there was a variation in glomerular charge between strains and that rats with the lesser charge were more prone to develop proteinuria including when rendered diabetic (Colin Paton). Rats with a lower charge of the GBM also had a lower charge on red cells. We showed that patients who had recovered from minimal change nephropathy or membranous nephropathy had a lower red cell charge than those with IgA nephropathy or the normal population. Thus inherited glomerular properties may be important in pathogenesis of glomerular diseases.
One interesting patient had serial relapses of minimal change nephropathy over several months, all of which responded to steroids. Cyclophosphamide did not prolong his remission. He then developed backache and had a lytic lesion on X-ray of a vertebra. Biopsy showed this to be tubercular. After this was treated, he went into permanent remission. We were able to show that lymphocytes of patients who were in remission produced more vascular permeability factor(s) than controls.
Nicola Joss showed that the rate of progression of diabetic nephropathy could be significantly reduced over a 2-year period by meticulous clinical care, of which blood pressure control was probably the most important.
Graham Warwick and Christopher Deighan collaborated with Christopher Packard in separate studies of the detailed changes in lipid metabolism of patients with proteinuria.
Perhaps the most notable contribution of all was made by Keith Simpson. Working first as a senior registrar and then as a consultant in the unit, he developed a computerised case records system which was used, not only in a clinical setting, but as a superb aid to audit thus raising clinical standards further. Colleagues, far and wide, eyed his system enviously. One even asked me, in rather an incredulous tone, “You do realise how lucky you are?” He accomplished this Herculean project while working as a full time clinician and even found more time to qualify for supervising in the Intensive Care Unit.
The computerised records were used to answer questions such as ‘Does early initiation of dialysis prolong survival on patients on dialysis’ or ‘is there a particular protein contained in proteinuria that is nephrotoxic?’ (Brian Mackinnon and Jonathan Fox.)
Keith’s expertise was recognised at national and international level.
I retired in 2003 having seen an ad hoc pioneering unit develop into a unit that helped to provide a much more complete and decentralised care to our patients.
First posted July 2025
Last Updated on July 20, 2025 by neilturn