Paediatric Nephrology

Specialist centres for the treatment of children with kidney disease emerged more slowly than for adults.

The first from  was in Glasgow  led by Gavin Arneil, the founding father of UK paediatric nephrology. In 1950 he published a seminal paper demonstrating the response of nephrotic syndrome in children to corticosteroids – the first treatable kidney disease.

From 1967 a paediatric unit was then established at Great Ormond Street Hospital directed by Martin Barratt, and another started also in 1967 in Manchester, led by Ian Houston.

Guy’s was another centre which started early to treat children, Until Cyril Chantler was appointed as the first paediatric nephrologist at Guy’s in 1972, children were treated there by the two adult nephrologists, Stewart Cameron and Chisholm Ogg working with consultant paediatricians without specific renal expertise.

It was not until 1973 that a specialist organisation for those interested in kidney disease in children was established – the British Association for Paediatric Nephrology – with Stewart Cameron the one non-paediatrician among its fifteen founding members.

The History of the First 30 Years of BAPN written by Dick White is about more than just BAPN and gives a first-hand account of the development of paediatric nephrology in the UK.

One factor in the slow development of children’s renal services was that there were no proposals for the treatment of children in the recommendations of the 1965 de Wardener working group which had outlined plans for 20 dialysis centres in the UK.  BAPN wrote a report in 1974 ‘Future care of Children with Chronic Renal Failure in the United Kingdom’ recommending that twelve paediatric centres were needed.  There was little progress but BAPN relentlessly pursued this   in a series of further reports, which gained little traction until a flurry of publicity and media interviews brought matters to a head, and the Department of Health approved the plan.

In an interview in 2018 Cyril Chantler recalled these events:  

“In 1973, Martin Barratt, Dick White and I said, ‘If we’re going to do this, we’re going to need to organise it on a national basis’. So we got out a population density map of the United Kingdom, we worked out where all the centres were and transport links. Then we looked where the adult nephrology units were and then we worked out where the universities were, where the academic paediatric departments were, and brought the whole thing together. And then we spoke to paediatric colleagues and to the Renal Association and the urological surgeons and so forth. It took us about two years and in 1974, we published ‘Future Care of Children with Chronic Renal Failure in the United Kingdom’. It was very well received by the Department of Health but it wasn’t funded. We at Guy’s somehow  got a home dialysis programme  going   which was eventually published in The Lancet, but the Government was not going to fund end stage renal failure treatment for children. So in 1979, the three of us with Ian Houston  wrote a progress report showing there had not been much progress. Failure’. Which was very well received but nothing happened. And meanwhile, it was getting really very difficult because we knew that this was something we should and could be providing (not necessarily for babies, that was another question, but certainly children and teens). And we found ourselves being economical with the truth when we talked to families about what the possibilities were until Dick White, bless him, could stand it no longer and he went public saying ‘I could be treating these children but I cannot’. And I can remember appearing on Panorama saying, ‘we can treat children in renal failure, but the government is not prepared to pay for it’ – which didn’t make me very popular! Then in 1983 there was a memorable moment. Mrs. Thatcher was interviewed (I think it was Panorama again) because there had been a case of an adult with leukaemia who needed a bone marrow transplant and hadn’t been able to get one. And they said to her, ‘Isn’t it time, you had a national programme, with  regionally based centres for this?’ And she said, ‘Well, it’s funny, you should say that. But that’s exactly our intention – to have some national programmes.’ Well, that was news to the Department of Health!

And so the following day, I got a phone call from Dr. Norman Halliday at the Department of Health, saying: ‘You know that report you did on progress for treatment?’ I said, ‘Yes’. He said, ‘we’re going to fund it. Can we talk to you about it?’ So we got it to happen, courtesy of Mrs. Thatcher.”

Last Updated on October 6, 2022 by John Feehally