Nephrology in Scotland developed in the late 1940s and early 1950s within the academic units of the four Scottish Universities: Prof Calum MacLeod in Aberdeen, Prof Arthur Kennedy in Glasgow, Prof James Robson in Edinburgh, and Prof Bill Stewart in Dundee. Each had a particular research interest within the developing specialty
Prof MacLeod’s special interest was in capillary pressure in acute glomerulonephritis, and the use of percutaneous renal biopsy in the diagnosis of different presentations of kidney disease.
There were few treatments of any value in the management of individual renal syndromes. Antihypertensive drugs were being developed but their use was limited in many cases by side effects. Steroid treatment of the nephrotic syndrome of childhood, minimal change glomerulonephritis, was in widespread use with protocols being devised and refined. The treatment of acute renal failure presented a major challenge. Despite careful medical management of causative factors and fluid balance mortality was high.
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Prof Hugh Dudley of the Department of Surgery pioneered the use of extracorporeal dialysis in Aberdeen in the early 1960s, treating patients with acute renal failure following surgery or major trauma.
By the late 1960s the technical aspects of haemodialysis had become sufficiently refined that its use was extended to the management of patients with chronic and progressive renal failure. Despite considerable administrative and financial problems Prof Calum MacLeod created a dialysis unit in an area on the north side of Ward 15 in Phase 1 of Aberdeen Royal Infirmary (ARI). The first patient, who had been receiving her regular dialysis in Edinburgh, commenced twice weekly sessions in Aberdeen in 1968.
The number of patients on regular dialysis steadily increased but was limited by space and the lengthy dialysis sessions, 14 hours twice weekly, usually overnight. Those with intercurrent illnesses or serious complications were admitted to the Professorial Medical Unit on Ward 1, putting great strain on capacity for general medicine and haematology.
Good circulatory access is a key factor in successful long term haemodialysis. In the early years Teflon shunts were placed in the radial artery and adjacent vein and connected by a silastic loop which could be opened for dialysis. Infection and blockage by blood clot were recurrent problems, but and by 1971 shunts were being replaced by arteriovenous fistulas which allowed vascular access by venepuncture. The skilled and unfailing attention of Mr Jetmund Engeset was key to this ‘sine qua non’ of dialysis.
The dialysers which were used when the Unit opened were large thick rigid plastic rectangular boards between which a sandwich of semipermeable membrane was created. The technicians who built these artificial kidneys were repeatedly exposed to blood when dismantling and cleaning them after each dialysis. Hepatitis B and other blood borne viral disease were a constant threat, but by skilled technique and strict working protocols no cases were encountered in Aberdeen. The problem was in large part resolved when the unit started using commercially available disposable single use dialysers in the late 1970s.
As the number of patients on regular dialysis increased an NHS consultant post to join Prof. Calum MacLeod was required. Dr Neil Edward was appointed in 1973, and a few years later Prof Graeme Catto joined Prof MacLeod in the University Department of Medicine further augmenting the consultant cohort.
Hospital space was a priority and the logical step to relieve the pressure was to develop dialysis in individual patient’s homes. Treatment facilities were installed and with help from a parent, spouse or partner patients self-dialysed. To coordinate the administrative complexities of this service a home dialysis administrator, Mrs Adrienne Fraser, was appointed.
For many reasons haemodialysis was not suitable for every patient, but peritoneal dialysis offered an alternative method. The technique was increasingly used from the mid 1980s.
The increasing complexity of monitoring equipment required the expertise of the Department of Medical Physics for servicing and advice on which of the many commercially available machines best suited our needs. David Shaw was the first technician but left after four years to pursue other career interests. He was followed by David Smith whose skills were recognised by his Medical Physics seniors and was soon promoted to a more responsible post. He was succeeded by Bill Mackie and then Douglas Smith and they forged a perfect team to secure this essential technical part of providing a long term haemodialysis service.
Grampian has a population of approximately 500,000 of whom about 200,000 live in Aberdeen and its suburbs. Inevitably the other 60% had to travel for treatment if home haemodialysis or peritoneal dialysis was not possible. The development of satellite units, often linked to a local “cottage hospital” was a natural extension. Local fund raising was a major factor in realising these developments. Satellit haemodialysis units were opened in Shetland, Orkney, Banff, Elgin, Inverurie, Peterhead, and Stonehaven.
Further consultant staff appointments followed as the work expanded. Prof Alison MacLeod, Senior Lecturer in Medicine, maintained the close link of nephrology to the University Department of Medicine. Prof. Andy Rees (Regius Professor of Medicine) and Dr Neil Turner were further University consultant appointees with interests in general nephrology. Dr Izhar Khan ,who had been Research Fellow with Prof. MacLeod, was appointed NHS consultant. Dr Carol Brunton’s promotion to consultant further augmented the senior nephrology staff level. Dr Ann Humphrey’s appointment in 1993 as Associate Specialist was with specific remit to the chronic dialysis service. This was key to recognising the importance of continuity of care of patients who attended the dialysis unit for many years a substantial number of whom had other non-renal medical problems; this was a virtual General Practice within a hospital setting.
From the beginning of the service the Renal Unit had superb surgical support for vascular and peritoneal access and for kidney transplantation. Mr Jetmund Engeset was a vascular surgeon in the University Department of Surgery who trained in renal transplantation in Gothenburg with Prof. Lars-Erik Gelin. Undoubtedly his drive and availability was a major factor in the success of the transplant service which from 1975.
Dr Neil Edward retired in 2000 and was succeeded by Dr Nick Fluck. Nephrology in Aberdeen entered the 21st century well-staffed and in excellent hospital accommodation.
Early research into metabolic bone disease involved Medical Physics applying neutron activation analysis to measure calcium in bones of the hand.
In the absence of a local cyclotron, a neutron source was acquired and stored within the renal unit in a large water tank to moderate the neutrons. The bones of the hand were chosen as the target because they could grasp the source encased in a plastic tube across the middle of the tank without irradiating the rest of the patient. In vitro studies indicated that repeated measurements provided reproducible results within acceptable radiation levels and corresponded with biochemical analyses. A clinical trial showed that the methodology was acceptable to patients. The data confirmed that the calcium content of bone could be measured while repeated assessments showed a slow but sustained decrease. These results stimulated widespread interest. Coincidentally the metabolism of vitamin D was becoming understood. The active component formed only in a normal kidney was synthesised in a Cambridge research laboratory and a small quantity brought to Aberdeen for a clinical trial which demonstrated the beneficial effect of that vitamin D metabolite and stimulated additional studies of other recently produced vitamin D metabolites in association with collaborators from outwith Aberdeen.
Work with Stan Urbaniak in Blood Transfusion identified non-cytotoxic alloantibodies associated with blood transfusion and their association with improved transplant outcomes.
In the early 1990s a study of the effects of age and comorbidity was novel enough to be published in the Lancet. Subsequent analyses included risk scores and associations with other factors such as staffing levels. With Aberdeen’s Health Services Research, and Health Economics units , we became founder members of the Renal Cochrane group. 15 systematic reviews followed, probing effective interventions and cost-effectiveness. Studies of AKI followed.
Neil Edward wrote the history of the clinical unit; information about research from Graeme Catto and Alison Macleod.
Neil Edward, 2023. This page first published Sep 2025.
Last Updated on September 27, 2025 by neilturn