Investigators in the UK have made transforming observations in the field of renal physiology and renal disease over the last two hundred years. Among the most seminal are the clinical case observations made by Richard Bright at Guy’s Hospital beginning in the 1820s, and published in his magisterial book : Reports of Medical Cases (1838). The links he made between albuminuria, kidney disorders and dropsy are among the fundamental building blocks of our modern understanding of kidney disease. And others followed Bright with further clinical insights including growing understanding of the natural history of ‘Bright’s disease (I.e. glomerulonephritis), and recognition of acute nephritis.
Another key moment was the first demonstration by Mohamed in the 1870s that blood pressure could be measured in humans
See more in Timeline: 1800s
As in all other branches of medicine progress relied on a small number of very bright and highly committed individuals who could somehow muster the time and the resources (often from their own personal wealth) to respond to their curiosity.
In the early part of the 20th century, renal research began to coalesce more formally in university departments of medicine, where a minority of academic clinical staff might be interested in kidneys and kidney disease. Or in university departments of physiology where normal kidney function was taught as part of the undergraduate medical school curriculum. See Academic or service.
Even by the 1950s there was a critical mass of established renal investigators in only a small number of academic departments of medicine in the UK – notably Manchester and the Royal Postgraduate Medical School (at Hammersmith Hospital, London). All research was curiosity-driven, and there were no specific funding streams for renal research. By the 1960s dialysis and transplantation and were emerging, and clinical nephrology became an established speciality. Renal clinicians and researchers soon diverged into two broad pathways: some (mostly younger) embraced dialysis and transplantation as clinically important, and began to direct their research towards these new treatment modalities and their consequences, as well other kidney disease mechanisms. An influential minority however eschewed the intense interest around dialysis and transplantation, some indeed suspecting they were not treatments that would last the test of time, others simply having other established research interests. This minority was older, and was influential because through the 1960s and 1970s they held a number of chairs of medicine in the UK, and therefore had impact on the major research directions taken. They were not clinical nephrologists in the modern sense, and if dialysis and transplant programmes were developed in their centres it was others (whether clinical academics or NHS consultants) in their hospitals who took the brunt of the clinical development work. Netar Mallick has described this influential generation as ‘nephrophiles’ rather than ‘nephrologists’ and they included some world class investigators. For example:
Douglas Black professor of medicine in Manchester and later PRCP, and Malcolm Milne (Manchester, Hammersmith, and then professor of medicine , Westminster Hospital)
Some did however bestride the worlds of renal physiology and clinical progress – for example Stan Peart FRS (professor of medicine at St. Mary’s Hospital, London), who discovered angiotensin and also led one of the UK’s earliest renal transplant programmes. And Hugh de Wardener (professor of medicine at Charing Cross Hospital) who was a world leading investigator in sodium metabolism and hypertension, as well as establishing one of the early HD programmes in the UK.
The Renal Association had been formed in 1950, and supported research only in the sense that it provided a forum for ‘nephrophiles’ to present their work. It had no funds for research, and investigators, unless they could solicit personal donations, had to rely on the highly competitive national sources such as MRC and Wellcome.
The stock of UK medical research was high, not least because of the rigour of clinical and research training in the UK, and through the advantage that English had emerged as the international medical language (albeit that it would gradually and relentlessly be replaced by American).
Nevertheless the scale of investment in biomedical research as well as clinical care in the USA from the 1950s onwards meant that American research opportunities were many and varied. From the beginning of clinical nephrology in the UK, the BTA (‘Been to America’) was virtually de rigeur for any young nephrologist ambitious to get a UK consultant job let alone develop a UK renal research career. UK mentors would use their transatlantic contacts to ensure their protégés gained a strong ‘BTA’ research training, which sometimes brought back new expertise to directly enhance the enabled then in due course to become independent investigators.
But the problem remained for those returning with their ‘BTA’ that research funding in the UK was very thin, and funding focused on renal research almost non-existent. A group of leading RA members therefore began the discussions in the early 1960s which led to the National Kidney Research Fund (later Kidney Research UK) being established in 1966. A smaller charity focused on childrens renal research was founded soon after, in due course known as Kids Kidney Research. These two remained the two UK funding body specific to renal research until the early 2000s, they merged in 2017.
NKRF’s funding was directed mainly at supporting bench research (as were most other biomedical research funders at that time), and a strength was its well organised and objective peer review process. Though much valued by those it funded, it began to come under criticism for the rather narrow range of work it supported, particularly as the range of excellent biomedical research generally in the UK was broadening to encompass for example more research with immediate patient benefit and clinical trials, as well as epidemiology and analysis of large data sets. Small disease specific charities also began to amass resources sufficient to support some research , for example the PKD Foundation and Alport UK. At the same time KRUK responded to its critics by broadening the range of its research funding calls, including some funding explicitly for early patient benefit, and broadened the membership of its research grants committee to ensure a wide range of applications received sound peer review. KRUK also began to invest not only in curiosity-driven research, but also in strategic funding streams, for example those designed to develop datasets and biobanks to be available to the wider research community. This involved KRUK in co-funding research with other organisations, with high worth individual donors, and with commercial partners, developing sound research governance arrangements to underpin these new partnerships.
The UK now has a vibrant research active kidney community, continually becoming professionally more broad-based since the turn of the century. A wide range of clinical practitioners as well non-clinical scientists are research active, and have realistic opportunities to obtain funding for their work. But an inevitable consequence of the growth in the kidney research community is that overall available funding will be insufficient even to fund all the highest quality research proposals; a frustration as old as biomedical research and unlikely ever to be fully assuaged.
The UK has made many and varied research contributions . In some fields the UK has had a particularly important leading role, and some of these are described in Great British Research.
Last Updated on January 22, 2024 by John Feehally