Erich Frank (1884-1957): unsung pioneer in nephrology.

The period between the 2 World Wars was a time of budding interest in renal studies and one that closed in major geopolitical unrest, culminating in World War II. The life of Erich Frank (1884-1957) and his contributions to chronic kidney disease provide considerable insight into this period. Frank began his career in Breslau, Germany. His medical thesis and first publication were on the benign nature of orthostatic proteinuria. He went on to define and differentiate essential from renal hypertension, presented evidence for the role of the posterior pituitary in diabetes insipidus, and studied the first oral hypoglycemic agent. As all clinical scientists then, Frank also contributed to other fields of medicine. When Germany turned to Nazism, Frank moved to Turkey, where he was appointed co-chair of the Department of Medicine of the newly established Istanbul University. For the next 23 years, he trained a new generation of modern physicians and laid the foundation of several medical disciplines in Turkey. As author of the first Turkish textbook of nephrology and a teacher who inspired his students, some of whom went on to become the first generation of Turkish nephrologists, Frank was a pioneer in nephrology who helped establish the discipline in his adopted country.

Hermann Senator and albuminuria--forgotten pioneering work in the 19th century.

Testing urinary albumin concentration by immune detection methods has recently turned out to be a highly rewarding procedure, as low level albumin excretion has turned out to be a powerful predictor of cardiovascular and renal risk in diabetic and nondiabetic patients. In the following we discuss a text dating back to the 19th century in order to make today's nephrologists aware of the remarkable and prescient, but meanwhile completely forgotten investigations on urinary albumin excretion in individuals without primary kidney disease. The treatise of Hermann Senator convincingly disproved the then held dogma that albuminuria was always a sign of primary renal disease. These observations are all the more remarkable since he was forced to use relatively simple and not absolutely specific methods. He further provided an explanation of the renal handling of albumin which to a large extent is still valid today.

Antonín vancura and arterial hypertension. 50 years' evolution in the conception of pathogenesis and treatment of the disease.

A historical overview of the important contributions of Prof. Antonin Vancura from Charles University Medical Faculty, Prague, to the broader understanding of the pathogenesis, clinical course and classification of arterial hypertension is given in his pivotal publication and first Czech monography 'High Blood Pressure'. His unique clinical series of 1,096 hypertensive patients with their long-term follow-up after 5, 10 and 15 years made it possible to work out the classification of hypertension not only on the basis of blood pressure readings, but also according to target organ damage--a principle which is close to the 2003 classification of the European Society of Hypertension/European Society of Cardiology (ESH/ESC). In agreement with today's conception, Vancura emphasized already in 1942 the importance of metabolic changes and albuminuria for prognosis of the disease. In spite of the technical, instrumental and laboratory limitations, it is possible to gain from Vancura's publication a modern interpretation of his results given by a long-term follow-up of this large group of patients. In many ways, Vancura outstripped his time and his concepts approached today's standings and so founded one of the important schools of hypertension in Czechoslovakia and Europe.

The origins of American nephrology (1800-1850).

Within a few years of its occurrence, American clinicians became aware of the discovery by Bright in 1827 that albuminuria in edematous patients was associated with granular degeneration of the kidney. Yet, there was a paucity of important original observations in nephrology from American in the first half of the 19th century. By the mid-19th century, however, the primitive concepts of clinical nephrology, renal physiology, and renal pathology were becoming established in the United States, after enlightenment from Europe. Because of the dreadful course of anasarca and uremia and stimulated by the advantages of innovations in microscopy, renal disease began at that time to attract the attention of eminent American clinician-pathologists. Their early observations would add to the knowledge base on which later developments such as bacteriology, radiology, clinical chemistry, and other scientific advances would build.