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The Artificial Kidney unit (AKU) was established in a side ward adjacent to ward 15/16 on the first floor of the Birmingham General Hospital in the city centre. The Ministry of Health apparently purchased 6 Kolff twin-coil kidney machines from Travenol Laboratories, USA for evaluation in 1961. The Department of Pathology and Experimental pathology had several MRC units under the direction of Prof. (later Sir) John Squire, and one machine may have been located in Birmingham as a result of this association.
Prior to 1961, patients with acute renal failure in Birmingham were transferred to Leeds General Infirmary for dialysis by Dr. Frank Parsons.
The Consultant physician in charge of the AKU was Dr. Dennis Blainey with Mr. Paul Dawson-Edwards, Consultant Urologist and the first medical registrar was Dr. David Dukes, who subsequently became a consultant renal physician at Walgrave Hospital Coventry.
Dr Barry Hulme followed David Duke’s as registrar in from July 1963 till moving to a consultant post at St Mary’s Hospital London in 1967. He wrote:
At that time there were no instruction manuals, reference books or medical publications. I watched and helped David for one week and then I was on my own with a surgical registrar to help with the insertion of femoral vein catheters into the groin.
The Kolff machine was basically a 100 Litre stainless steel tub with a central open-topped can and a pump that circulated the dialysis solution around the twin-coil. The manufacturer provided details of the weights of the individual chemicals to be added to the 100 litres of water in the tank. Each chemical was weighed out and placed in a glass bottle in hospital pharmacy and then mixed in a plastic bucket using a wooden spoon when the machine was being prepared. The pH was adjusted with lactic acid and carbon dioxide was bubbled through the tank throughout dialysis. Each treatment for acute renal failure usually lasted 6 hours and the dialysis solution was changed every 2 hours.
Disposable artificial kidneys had a large “dead space” and the coils had to be primed with two units of blood. The patient and the extra corporeal system were anti coagulated with heparin. In appropriate cases, regional heparinisation was used.
Ward 15/16 at the General Hospital was an ENT ward and not ideal for the type of referred patient, as they required intensive care. In late 1963 the unit was transferred the Professorial Surgical Unit on in the west Wing of the Queen Elizabeth Hospital adjacent to the main University Campus in Edgbaston. The facilities were much better and a wide range of surgical expertise was readily at hand. As the success of haemodialysis spread through the Midlands, many more patients were referred for treatment on the single machine; we decided to treat two patients simultaneously on the upper and lower coils of the dialyser. The technique was described in the Lancet (Lancet, 1965, 1, 724).
In 1980, there was a transplant service at the Queen Elizabeth Hospital (Edgbaston, adjacent to the University of Birmingham site), overseen by Tony Barnes. For some years this unit had also been transplanting patients from Oxford. Barnes was also in charge of a 5-station dialysis unit, which had about 12 patients – one of several dialysis set up primarily to support transplantation, when this was perceived to be the only viable long term possibility. Paul McMaster joined Tony Barnes as a transplant surgeon around 1979, and introduced the use of cyclosporin.
At the East Birmingham Hospital a larger service run by Drs Brian Robinson and John Hawkins established a home haemodialysis programme. Dr Jonathan Michael, who had trained at Guy’s Hospital, was appointed as consultant nephrologist and general physician, and was joined in 1981 by Dr Jo Adu, also from Guy’s. With Michael leading the clinical service, and Adu leading the research, the pair argued strongly and contentiously for more resource for renal failure, from the region with the lowest treatment rate, in a country with an exceptionally low treatment rate for the time. Initial expansion was through the use of CAPD, until more 80% of their patients were treated this way, but this was not found to be sustainable. Patient numbers grew from 12 in 1980 to around 300 by 1990.
Influenced by the experience of Victor Parsons and the unit at King’s, they abandoned some of the ‘suitability’ criteria used elsewhere to decide who should receive treatment with limited resources. Two notable legal cases influenced provision locally and nationally.
Further expansion of haemodialysis was made possible by establishing satellite units at Hereford and then Aston. These were the first in the UK to entail contracts with an external company which owned the unit and machines, and employed nursing and support staff, while medical care was provided by the main renal unit team.
In 2010 all services were moved to the adjacent new Queen Elizabeth Hospital building.
From the 1950s, the University of Birmingham working with clinicians had been studying proteinuria and the nephrotic syndrome. Professors Squire, Blainey, Brewer and Soothill (before he moved to Great Ormond Street Hospital) had developed the concept of selectivity of proteinuria, and characterized renal histology in nephrotic syndrome. They worked in the Department of Experimental Pathology that combined clinical as well as experimental studies a concept well ahead of its time. At the same time Professor Dick White a paediatric nephrologist and later the pathologist Dr Rafaat at the Childrens Hospital in Birmingham were studying the histology and treatment options in childhood nephrotic syndrome. Dick White had earlier worked in Uganda to classify the nephrotic syndrome associated with Plasmodium malariae.
Dr Adu inherited Prof Blainey’s Research laboratory, moving the major focus to the immunopathogenesis and immunogenetics of glomerular and endothelial injury in lupus nephritis and ANCA associated systemic vasculitis. Clinical research was focussed on the development of randomised controlled trials for the treatment of systemic vasculitis. During this time, we worked closely with the pathologists Professor Brewer and Alec Howie to describe the clinical aspects of the glomerular tip lesion.
Last Updated on August 14, 2023 by neilturn