IAHN
Editor-in-Chief: Janusz Ostrowski Deputy Editor-in-Chief: Davide Viggiano Editors: Maria Kalientzidou, Guido Gembillo IAHN Bulletin is the official E-Newsletter of the International Association for the History of Nephrology
Bulletin
No. 12, June 2024
www.iahn.info
Despite the very difficult and complicated political situation in the world, scientific societies, including our own, continue to fulfil their statutory roles without interruption. The editorial team of the Bulletin of the International Society for the History of Nephrology proudly presents its 12th issue to our readers, society members, and supporters. We are striving to make the Bulletin increasingly attractive. This issue features a slightly revised graphic design, which we hope will be well received by our readers. Among the authors of the publications are our regular contributors, Natale De Santo, Katarina Derzsiova, Maria Kalientzidou, Guido Gembillo, Malcolm Philips, and Andrzej Więcek. The main topics include works on two distinguished nephrologists who have passed away this year, Zbylut Twardowski and Dimitar Nenov; publications related to the 100th anniversary of the first human haemodialysis; a report from the conference dedicated to Stewart Cameron in London; information about important nephrology-related events in Poland; and the latest news about the upcoming IAHN congress in Naples, Italy. Since the IAHN Bulletin is an e-newsletter, we have even greater publishing capabilities. We encourage all readers to submit materials about notable individuals and events in their respective countries, achievements of IAHN members, and historical articles. We are all eagerly anticipating the opportunity to gather with friends in Naples, which we hope will be another important step in the development of our society. I wish everyone a wonderful holiday and a good rest. Janusz Ostrowski Editor-in-Chief
Janusz Ostrowski
Board of the International Association for the History of Nephrology
President - Ayse Balat PAST President - Iwannis Stefanidis President ELECT - Davide Viggiano TREASURER - Vincenzo Savica EX OFFICIO - Natale De Santo
INTRODUCTION
Professor, Department of the History of Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland janusz.ostrowski@cmkp.edu.pl
Janusz Ostrowski
One hundred years ago, in 1923, Georg Haas (1886-1971) performed the first haemodialysis on a human being in the German city of Giessen . Before him were John Abel, Leonard Rowntree and B. Turner from Johns Hopkins University in Baltimore were the first scientists to apply the concept of dialysis to dogs. Haas designed a dialyser that used collodion tubes with Ringer's solution as the dialysate. As for anticoagulation, he was also the first to consider a possible role for citrate, but was ultimately convinced that hirudin was the better choice, regardless of its cost and toxicity. The aim of this first haemodialysis was merely to prove its safety, and therefore the procedure lasted only fifteen minutes. Between 1925 and 1926, another 5 patients were dialysed, but the toxicity of hirudin prevented further improvements. In 1928, the newly available anticoagulant heparin enabled Haas to treat three more patients with what was known as fractionated dialysis, in which 400 ml of blood was taken from the patients, heparinised and then passed through the dialyser in nine separate sessions. The German scientist also noticed the decrease in blood volume, which he attributed to the overpressure in the blood compartment. He was also the first to consider haemodialysis as a possible treatment for nephrotic oedema. When he presented his work at a medical congress in Wiesbaden in 1927 , he was severely criticised and abandoned his work. Looking back on his journey, he said: "From the first idea to the actual realisation of the dialysis method was a very long way. I would say it was a via dolorosa!". Despite all the difficulties, his experiments contributed significantly to a better knowledge of haemodialysis and represented a milestone in the field of nephrology. References: 1 Haas G. Dialysis of the flowing blood in the patient. Klin Wochenschr 1923: 70, 1888. 2 Haas G. Die Methoden der Blutauswaschung. Aberhandeln’s hanb Biol Arbeitsmethoden V 1935 (8): 717-754
Janusz Ostrowski
A CENTURY AFTER THE FIRST HUMAN HAEMODIALYSIS, A MILESTONE IN NEPHROLOGY.
1 University of Messina, Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, Messina, Italy. 2 Italy University of Messina, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Messina, Italy. 3 A. Monroy Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo.
Guido Gembillo 1,2 ; Guido Bellinghieri 1 ; Luigi Peritore 1 ; Vincenzo Savica 2 and Domenico Santoro 1
Introduction Once upon a time, a young doctor was prescribing in despair the “death recipe” for his patient dying from uremia. All that he could offer was early euthanasia. “…Paraldehyde gives a very natural and dreamless sleep. The dose can be repeated whenever the patient shows signs of restlessness and the quantity given can be safely increased up to as much as 60cc every 6hr or so, for here also uremia seems to carry with it a greatly increased tolerance, and there is a wide margin between the dose that makes the patient just drowsily unconscious and the amount required to induce a deep sleep. It is the quiet drowsiness we want. The disease itself will soon bring the deep sleep. [1] “ Once upon a time, a young doctor was shocked by the sudden death of his favourite 26 years old actress Jean Harlow “On June 6, 1937, Harlow said that she could not see Powell clearly and could not tell how many fingers he was holding up. That evening, she was taken to Good Samaritan Hospital in Los Angeles, where she slipped into a coma. The next day at 11:37 a.m., Harlow died in the hospital at the age of 26. In the doctor's press releases, the cause of death was given as cerebral oedema, a complication of kidney failure. Hospital records mention uremia…[2]…” Once upon a time back in the 19th century, a Scottish chemist Thomas Graham was studying in his chemical laboratory and publishing his work about the methods of osmosis and dialysis used for the separation of dissolved substances or the removal of water from solutions through semipermeable membranes. He introduced the concept of diffusion across a semipermeable membrane, termed it “dialysis” in 1861[3,4]. Once upon a time, three scientists (Abel JJ, Rowntree LG, Turner BB) applied the principle of diffusion to the removal of substances from the blood of anaesthetized animals. They dialyzed them by directing their blood outside their body and through tubes of semipermeable membranes made from a material based on cellulose[5]. In two papers published in 1914, they gave a much more detailed account of their apparatus which they called an artificial kidney[6,7]. They tried to inhibit blood clotting or coagulation by using a substance known as hirudin, which had been identified as the anticoagulant element in the saliva of leeches in 1880. The very high price of hirudin, USS 27.50/g in 1914, just enough for two experiments, forced them to prepare their own leech extracts, but they were very toxic, so they abandoned this field of investigation and the potential use of the artificial kidney in humans. Heparin had not yet been discovered. Once upon a time, a German doctor (Georg Haas) started performing preparatory experiments on dialysis treatments involving humans. It is believed that he dialyzed the first patient with kidney failure in the summer of 1924 and this first human dialysis lasted only 15 min. By 1928 he had dialyzed six patients, none of whom survived, likely because of the critical condition of the patients and the ineffectiveness of the dialysis treatment[8,9]. He stated : “…. I know that one swallow still doesn’t make a summer- but despite the limited number of observations, I have already gotten the distinct impression that is worth the effort to continue along the path taken.” He also used hirudin as the anticoagulant in his dialysis treatments. Once upon a time, in the fall of 1945 science credited a doctor from the Netherlands, Willem Kolf, with the first successful dialysis in humans. He used a rotating drum kidney with membranous tubes made from a new cellulose- based material known as cellophane. The blood-filled tubes were wrapped around the wooden drum that rotated through an electrolyte solution, the dialysate, causing the uremic toxins to pass into this rinsing liquid[10,11]. Heparin already adopted by Hass in 1937, replaced the toxic and expensive hirudin. Once upon a time dialysis was not indicated for treatment of chronic renal failure. Kolf stated in 1946: “Chronic nephritis is no indication for treatment with the artificial kidney, though an acute exacerbation of chronic uremia might be an indication in some cases. An acute uremia, whatever the cause may be, is an indication for treatment with the artificial kidney as soon as it immediately threatens the patient’s life…..” [12]. Once upon a time, a tale of continuous improvements and technological advancements began concerning the effectiveness of dialyzers, methods of dialysis, machine modification, and vascular access. Once upon a time, the expectation of long-term treatment of patients with chronic kidney failure became true. In 1960 Scribner implanted a shunt in an American patient[13]. This success provided the basis for the chronic hemodialysis sessions. Once upon a time (in the early 1970s) dialysis treatments lasted around 12 hours and were very expensive. Consequently, not all patients had access, choices about who would receive dialysis were made by an anonymous committee, the first bioethics committee. External shunts were followed in 1967 by the work of Brescia and Cimino[14] which was followed by the development of synthetic grafts and central vein double-lumen catheters in the 1980s. Once upon a time a breakthrough of developments started concerning dialysis facilities, technical advances, dialysis machines with proportioning pumps, improved monitoring devices, bicarbonate dialysis, drugs (new antihypertensive, vitamin D derivatives, parenteral iron compounds, erythropoietin) long nocturnal or short daily dialysis. Dialysis: a life-prolonging or a life-saving process but not a life-«salving» process Dilemmas concerning the life-prolonging or life-saving character of dialysis treatment are prominent, especially in the elderly and how to identify and deal with the concept that dialysis treatment seems to prolong suffering and the process of dying rather than adding quality days to the patient's life. A crucial “trilemma” then arises: whether dialysis treatment can be considered life-saving, life-prolonging or life-«salving» since dialysis-treated patients may often continue to experience feelings of anxiety, insecurity, frustration escorted by guilt over the burden on the family and poor quality of life under hemodialysis treatment. It is well known that hemodialysis, particularly intermittent, is a non-physiologic, physio-chemical treatment and is unable to restore the constancy of the internal environment achieved by the kidney. Raghavan and Eknoyan pointed out: “Suffice it to say that dialysis is an empiric treatment. There are no clinical trials or experimental studies of the long-term effects of dialysis on normal bodily functions, either in the presence of normal or reduced kidney function. Similarly, there are no studies of the long-term cardiovascular effects of arteriovenous fistulas, no matter how modest their continued blood flow may be. Dialysis operates on principles that are the very opposite of what homeostasis is all about. Where homeostasis is fine-tuned to adjust and maintain the normalcy of any abnormal change in the composition of the bodily fluids to a mean or median within a rather narrow range of “normal”, dialysis provides no such fine adjustment or maintenance……”[15]. These comments do not underestimate the life-saving effect that dialysis provides. According to the authors’ concept for any given patient the moral difference between prolonging dying, life-prolonging and life-saving may be “artificial”, especially in the case of dialysis where the prolonging/saving life (which is always of the first importance of a treatment) of the patient extends to many years in the majority of patients. Hence if all our days are of equal worth, it would seem to follow that the dying days of a patient would need to be prolonged no less vigorously than any other days. To speak of a treatment which prolongs dying is probably a misleading way to speak of treatment which prolongs life provided that we can distinguish between those patients who are dying and those who are not. The term dialysis comes from the Greek word which in the Greek language has a double meaning: firstly the scientific one refers to the separation of crystalloids from colloids in a solution by diffusion through a membrane and secondly, the rational one refers to adverse happenings suddenly occurring, causing great damage. In the case of end-stage renal patients, the first one applies to the hemodialysis process and treatment of the renal patient the second, sometimes more prominent, to the life of end end- stage renal disease patient. In the future, there are expectations concerning novel more challenging and promising approaches (artificial intelligence, stem cells, kidney organoids) that improve the quality of life of renal patients. Conclusion Once upon a time, they did not live happily ever after. This nephrology tale has no end. On the contrary, scientists continue to be challenged, to hope, to be in despair, to be shocked, to study, to apply, to try to inhibit, to abandon, to perform experiments, to continue along the taken path and always working for the beneficence of human suffering and disease. I always remember the words of a patient of mine who was on dialysis treatment for 15 years and died 48 years old: “During the first half of my treatment I was fighting to live and the second half to die”. Α struggle in which desperation and serenity and resignation and routine and fatigue and silence coexist. In conclusion, after the initial 100-year-old revolutionary concept of dialysis treatment, a question and a “demanding” wish to hover over the need for the urgent emergence of an equally innovative concept that will be the “salving” treatment for patients with end-stage chronic kidney disease. References 1. Addis T: Glomerulonephritis diagnosis and treatment. New York: Macmillan Company 1949. 2. Pitkin, Roy: Whom the Gods Love Die Young: A Modern Medical Perspective on Illnesses that Caused the Early Death of Famous People.RoseDog Books December 10, 2008. Dorrance Publishing. ISBN 978-1-4349-9199-7. 3. Graham T: The Bakerian Lecture on Osmotic Force. Phil Trans R Soc Lond 1854; 177-228. 4. Graham T: Liquid diffusion applied to the analysis.Phil Trans R Soc Lond 1861; 183-224. 5. Abel JJ, Rowntree LG, Turner BB: On the removal of diffusable substances from the circulating blood by means of dialysis. Transactions of the Association of American Physicians, 1913. Transfus Sci. 1990; 11(2):164-5. PMID: 10160880. 6. Abel JJ, Rowntree LG, Turner BB: On the removal of diffusable substances from the circulating blood of living animals by dialysis. J Pharmacol Exp Ther 1914; 5:275-316. 7. Abel JJ, Rowntree LG, Turner BB: On the removal of diffusable substances from the circulating blood of living animals by dialysis II: Some constituents of the blood J Pharmacol Exp Ther 1914; 5:611-623. 8. Haas G: Versuch der Blutauswaschung am Lebenden mit Hilfe der Dialyse, Klin Wochenschr 1925; 4:13-14. 9. Haas G: Uber Blutauswaschung. Klin Wochenschr 1928; 7:1356-1362. 10. Kolff WJ, Berk HTJ, ter Welle M, van der Ley AJW, van Dijk EC, van Noordwijk J: The artificial kidney: A dialyzer with great area. Acta Med Scand 1944; 117:121-134. 11. Kolff WJ: The Artificial Kidney. Kampen, Kok, 1946. 12. Gottschalk CW, Fellner SK. History of the science of dialysis. Am J Nephrol. 1997; 17(3-4):289-98. doi: 10.1159/000169116. PMID: 9189249. 13. Scribner BH, Buri R, Caner JE, Hegstrom R, Burnell JM. The treatment of chronic uremia by means of intermittent hemodialysis: a preliminary report. Trans Am Soc Artif Intern Organs. 1960 Apr 10-11;6:114-22. PMID: 13749429. 14. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966 Nov 17; 275(20): 1089-92. doi: 10.1056/NEJM196611172752002. PMID: 5923023. 15. Raghavan R, Eknoyan G. Uremia: A historical reappraisal of what happened
. Clin Nephrol. 2018 May; 89(5): 305-313. doi: 10.5414/CN109401. PMID: 29451473.
Janusz Ostrowski
ONCE UPON A TIME: A FAIRY TALE FOR THE 100 YEARS SINCE THE FIRST CONCEPT OF HEMODIALYSIS
Renal Unit/Nephrology Department, General Hospital of Kavala, Greece
Maria Kalientzidou
Janusz Ostrowski
DIMITAR NENOV (1933 - 2024), THE DOYEN OF BULGARIAN NEPHROLOGY, DISTINGUISHED PROFESSOR AT THE UNIVERSITY OF VARNA BEHIND THE IRON CURTAIN AND PRESIDENT OF BULGARIAN BRANCH OF PROFESSORS EMERITI
1 University Luigi Vanvitelli Naples, 2 Division of Nephrology University of Messina, 3 Scientific Director of Biogem, Ariano Irpino (AV), 4 Division of Nephrology Annunziata Hospital Cosenza, 5 Migration Center University of Calabria at Rende, 6 Division of Nephrology Cassino Hospital, 7 Founder of Ph.D. Course in Ecology at the University Federico II, Naples, 8 Nephrological Laboratory, University hospital of Louis Pasteur, 9 Louros Foundation, Athens, 10 Division of Nephrology University of Sarajevo, 11 Consultant in General Internal Medicine, East Surrey Hospital, Redhill, London
Natale G. De Santo 1 , Guido Bellinghieri 2 , Giovanbattista Capasso 3 , Nicola De Napoli 4 , Vincenzo Savica 2 , Teresa Papalia 4 , Pantaleone Sergi 5 , Luigi Iorio 6 , Amalia Virzo 7 , Katarina Derzsiova 8 , Halima Resic 9 , Athanasios Diamandopoulos 10 , Veselin Nenov 11
Early Life and Studies Dimitar Nenov(Figure 1), was born on May 2, 1933 in the village of Pobit Kamak, district of Razgradin in Bulgaria. He had just completed primary school, when, due to the Socialistic Revolution of September 9, 1944, Bulgaria entered in the orbit of USRR and collectivism became the new state model and his family property were confiscated. He completed Junior high school in Pobit Kamak and the high school in in the town of Russe. He registered at the Medical High School of Sophia and was a brilliant student. He obtained the MD in 1957. Before completing the medical studies he got married with Liliana, a future Professor of Modern Languages. Physician in the District Hospital of Burgas. Trainining in Internal Medicine and Nephrology Dimitar moved to the District Hospital of Burgas, the hometown of his wife. In 1962 he specialized in Intenal medicìne and moved to the Chair of Medical therapy in the newly founded Medical School of Varna. He was appointed assistant (1962) and later senior teaching assistant (1966). He decided to specialize in Nephrology, a branch of medicine in
great expansion that had been recently recognized worldwide. He looked for an international training that at that time was available in a few places due to the vision of a few internists who wanted to explore the possibilities offered by technology and organ transplantation (the kidney was the first organ successfully transplanted). He could join the training programs in nephrology of the Universities of Prague (Professor Jan Brod), and in later years Bologna (Prof. Vittorio Bonomini), Parma and Moscow. In Prague he worked at the Institute of Cardiovascular Research, a WHO Center for training on Cardiovascular and Kidney disease. Brod, a libertarian who had fought nazism and contributed to liberate Italy from fascism and participated in the bloody Battle of Montecassino (17 January-18 May 1944), reinforced Dimitar’s love for freedom. Academic career The whole academic career of Dimitar Nenov took place at the University of Varna. He obtained Ph.D. in Nephrology in 1969 and a Doctorate in Medicine (DM) in 1975. He became associate professor in Medicine and Director of the Nephrology Clinic in 1973, and of Full Professor of Medicine in 1985. He was Chief of the United Department of Internal Medicine (1987- 1992) and from 1988 till retirement he was Chief of the Division of Nephrology and Hematology. He organized nephrology with international standards (Clinical Nephrology, biopsy, hemodialysis, peritoneal dialysis, plasmapheresis, LDL Apheresis) and attracted to nephrology a huge group of young investigators. He also served two 4-yar terms as Vice Rector. In 1979, a time when the exchange between Bulgaria and Westerns was difficult he organized in Varna the 4th Danube Symposium in Nephrology . The event was held at a time when Bulgaria was under socialism and scientific exchanges between Eastern and Western Europe was very limited. A great number European scientist participated. In 1986 he organized the 3rd National Conference in Nephrology with the participation of 70 nephrologists from abroad. In 1989, at a time the Berlin Wall was still in place, he was one of the organizers of the 6th European Colloquium on Renal Physiology in Varna that took place at the Press House: A cultural event relevant for the University and the City. In 1991 Dimitar Nenov gave birth to the Varna Kidney Foundation and from this Foundation he established an Annual International Conference named “Hot topics in nephrology” and the journal Aktualna Nefrologia . He became a co-founder of the International Federation of Kidney Foundations (IFKF). At that time he also established and tightened the long- term partnership with Italian colleagues from Naples, Cosenza and Messina (Table 1.) Table 1 - Collaborations in Italy.
Figure 2
Figure 3
Figure 1
“The idea of the founders was that such Society would have a clear impact on several aspects of practice and research in nephrology and artificial organs in the Balkans. In addition, it would be a very positive symbolic act showing that collaborative work for the betterment of life is possible and desirable in our area and that coming together will bear better fruits at the human and cultural levels… It will also send a very clear signal to the outside world that the Balkans can be a place of collaboration and mutual understanding despite the turbulent times in the Balkan Peninsula” (1). The First BANTAO Congress was held in Varna on September 22-24, 1995, an impressive event under the chairmanship of Dimitar Nenov. Professor F. Valderràbano, delegate of the European Renal Association published a congress report: “Nephrologists of the Balkan countries meet across political frontiers and war fronts - an example to politicians! (2).” “BANTAO: a new European medical association overcomes political obstacles. This is an extraordinary initiative of nephrologists working in cities throughout the Balkan countries who have been able to create a scientific association and to organize its first congress, despite the boundaries of war, the rupture of international relations and other serious political problems which emerged in the Balkan countries after the disappearance of the former Republic of Yugoslavia”. The BANTAO Journal Another milestone in the life of BANTAO was the appearance of the BANTAO Journal (Figure 4) in 2003, on occasion of the VI Congress that Dimitar Nenov organized again in Varna (3). Professor Momir Polenakovic years later reporting on that event wrote: “The historical editors of the journal were: 2003–2005 (Dimitar Nenov); 2005–2009 (Ali Basci); 2009–2015 (Goce Spasovski). The BANTAO Journal is now registered on EBSCO, DOAJ, SCOPUS, and has become a strong 'glue' among nephrologists from the Balkan cities. The BANTAO congresses and the BANTAO Journal have succeeded in elevating nephrology knowledge and thus increased the standards of nephrology patient care throughout the Balkans. Standing above the divisive forces of politics, language and war, BANTAO gives a living example that collaboration and humility are feasible in times of maddening destruction” (4).
Figure 4
Figure 5
The Bulgarian Association of Professors Emeriti Dimitar Nenov founded with 10 other Colleagues the Varna Emeriti Association of Professors Emeriti in Varna. Three of them were registered in EAPE, and one of them came as delegate to the Athens International Congress. It was the last collaboration he had with Naples. Epilogue Dimitar spoke Russian, French, English, Czech Serbian. A handsome man, with a musical voice used to whisper arias from operas. After retirement he was appointed Expert of the National Health System and consultant of local hospital. He also started a private dialysis unit in Varna and directed it till 2022. A brain tumour caused his death on February 2, 2024 in Varna, the City he had loved, the city of the medical university he had served working hard with his contagious enthusiasm, the city where his children were born and his wife still lives. References 1. Polenakovic M and Spasovski G. Ideas abd spirit of the Balkan Cities Association of Nephrology, Dialysis, Transplantation and Aartificial Organs (BANTAO) connect nephrologists from the Balkan cities- From the fpundation to the 15th BANTAO Congress.. Macedonian Academy of Science and Arts, Sec. of Med. Sci. 2019; XL (3): 1-25. 2. Valderrábano F. Nephrologists of the Balkan countries meet across political frontiers and war fronts--an example to politicians! BANTAO: a new European medical association overcomes political obstacles. Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs. Nephrol Dial Transplant. 1996 Apr;11(4):740. doi: 10.1093/oxfordjournals.ndt.a027379. PMID: 8671877. 3. Nenov D. BANTAO Journal, Journal of the Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, Varna, Kidney Foundation. BANTAOJ. 2003; 1(1):1-3 [Google Scholar]. 4. Polenakovic M and Spasovski G The 20th anniversary of BANTAO (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs) Clinical Kidney Journal,2014; 7 (2): 224–226. 5. De Santo NG, De Santo RM, Perna AF, Anastasio P, Bilancio G, Pollastro RM, Di Leo VA, Cirillo M. To survive is not enough. Quality of life in CKD--the need for a new generation of health-oriented economists.J Nephrol. 2008 Mar-Apr; 21 Suppl 13:S32-50.PMID: 18446731 6. .De Santo N.G., De Santo R.M.,Bilancio G,.Perna A M., Cirillo M. Survival is not enough. Actualna Nefrologia (Varna) . 2009; 9 (in Cyrillic): 2-9
Dimitar Nenov developed clinical nephrology in Bulgaria, especially in Varna (1) and contributed significantly to the establishment of the Balkan Cities Association of Nephrology, Dialysis, Transplantation, and Artificial Organs (BANTAO). He is also credited with the birth of the BANTAO Journal.      The BANTAO was founded in Ohrid, Republic of Macedonia, on 9 October 1993. At that time, war was raging in the Balkans. The war sparked hatred among the people and the countries of the Balkan Peninsula, and that is why they used the names of cities instead of countries to establish the BANTAO. To overcome the obstacles, a working group of representatives of different Balkan cities was formed in cooperation with representatives of Western European countries, e.g. Horst Klinkmann, Joerg Vienken, Peter Ivanovich, and others (2,3).     The main objective of the BANTAO was in promoting scientific and technical cooperation in the field of kidney diseases and artificial organs among the cities of the Balkan Peninsula and the international nephrology community. The establishment of the BANTAO was a testament to the dedication and willingness of the nephrologists of the Balkan Peninsula to cooperate together for the benefit of patients, for the advancement of medical science, and for collaboration with the world's nephrology societies. It was a clear example that compassion and humility are feasible even in the turbulent Balkan Peninsula.    The first BANTAO Congress was held in Varna, Bulgaria, in 1995 (when the Balkan wars were still at their peak) under the presidency of Dimitar Nenov. Since then, BANTAO congresses have been held once a year or every two years in different cities of the modern Balkans. Professor Mydlík of the University of Košice actively participated in the 6th BANTAO Congress in Varna at the invitation of Professor Nenov, in the 7th Congress in Ohrid at the invitation of Professor Polenaković, and in the 8th Congress in Belgrade. I participated together with Professor Mydlík at the 9th -11th Congresses (Antalya, Rixos Sungate Hotel; Halkidiki, Sunny Beach Hotel; and Timisoara, Timisoara Hotel), (Fig 1, 2.).
Survival is not Enough. In 2007 the Italian Institute for >Philosophical Sties launched an initiative names Survival is not Enough to support the needs of patients with chronic kidney disease throughout Europe, with the same format around the World Kidney Day. The annual meeting in the years 2007-2020 took place in more than 70 cities in Europe in Northern Africa (5). Everywhere the same topic and format, inviting to debate : patients on dialysis or transplanted, living kidney donors, family members of deceased organ donors, nurses, technicians, economists, health administrators, jurists, magistrates, psychologists, philosophers bioethicists, pediatricians, nephrologist, neurologists, psychiatrists, transplant surgeons, journalists, medical editors renal patients and their associations. In 13 years the event took place in some 80 cities including repeatedly Naples, Tunis, Milan, Koper, Bari, Messina, Athens, Gdansk, Cairo, Kosice, Trieste, Rome, Istanbul, Tokyo, Gaziantep, Nagoya, Bucharest, Portaria, Adana and Varna (5,6). The idea was to put the patients in the center of the health systems worldwide. “Put the patients at the centre of things. Let the System again fit the patient, stop the tradition of the patients fitting the System. Stop thinking that resources are limited and demands exceed supply, and both are unpredictable. Think that demand is finite and predictable, supply is flexible and manageable. Clinicians should stand in patients’ shoes and seeing things through their eyes” . (Fiona Godlee, Editor BMJ 2009; 338.b588, Feb 12). Varna was one of the most active centres and collaborated to various publications of the Italian Institute for Philosophical Studies (Figure 5).
Fig 1. 6 th -11 th BANTAO CONGRESS in Varma, Ohrid, Belgrade, Antalya, Sani Chalkidiki, Timisoara
6 th BANTAO CONGRESS in Varma, 2003
6 th BANTAO CONGRESS in Varma, 2003
7 th BANTAO CONGRESS in Orhid, 2005
7 th BANTAO CONGRESS in Orhid, 2005
8 th BANTAO CONGRESS in Belgrade, 2007
8 th BANTAO CONGRESS in Belgrade, 2007
9 th BANTAO CONGRESS in Rixos Suntage Hotel (Belek), Antalya, 2009
9 th BANTAO CONGRESS in Rixos Suntage Hotel (Belek), Antalya, 2009
10 th BANTAO CONGRESS in Sani Beach Hotel, Sani, Chalkidiki, Greece, 2011
10 th BANTAO CONGRESS in Sani Beach Hotel, Sani, Chalkidiki, Greece, 2011
11 th BANTAO CONGRESS in Timisoara Hotel, Romania, 2013
11 th BANTAO CONGRESS in Timisoara Hotel, Romania, 2013
Fig 2. 8 th BANTAO Congress in BELGRADE
Crown Prince Alexander of Serbia and professors Dimitar Nenov and Miroslav Mydlík
Participants at the 8 th BANTAO Congress
Miroslav Mydlík and Dimitar Nenov
Fig 3. Awarding the „Doctor Honoris Causa“ of P.J. Šafárik University to Professor Bonomini and 7th International Nephrological Symposium in Košice, October 5,2006
Vittorio Bonomini and Dimitar Nenov
Vittorio Bonimini and participants at Dr.H.c.
From the left: Outstanding professors: F. Kokot, G. Bellinghieri, V. Savica, D. Nenov, M. Mydlík, V. Bonomini, W. Sulowicz
Dimitar Nenov, Guido Bellinghieri, Władysław Sulowicz
Sightseeing Tour in the Historical Part of Košice
Professor D. Nenov visiting „Nephron“, the private Dialysis Center in Košice
Fig 4. Farewell to Dimitar Nenov
Dimitar Nenov
References 1. Remembering Prof. Dr. Dimitar Nenov: A Tribute to the Doyen of Nephrology. February 5, 2024 by world today news. 2. Polenakovic M and Spasovski G. The 20th anniversary of BANTAO (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs). Clin Kidney J 2014; 7: 224–226. 3. Polenakovic M , Nenov D, Basci A, et al. 20 years since the establishment of the BANTAO association (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs). Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2013;34(2):181-213. 4. Mydlík M, Derzsiová K, Farkaš M et al. Renal Tubulo-interstitial Impairment in Acute Intermittent Porphyria and Variegate Porphyria. BANTAO J 2003; 1(2): 198-200. 5. Mydlík M, Štubňa J, Tóth Š, Derzsiová K, Molčányiová A. Continuous Ambulatory Peritoneal Dialysis and Pulmonary Functions, BANTAO J 2003; 1(2): 195-197. 6. Derzsiová K, Mydlík M, Petríková V, Molčányiová A. Haemoperfusion of Amitriptyline and Nortriptyline an in Vitro Study. BANTAO J 2006; 4(2): 1-4. 7. Mydlík M, Derzsiová K. Nephrologist and Intensive Care Unit. BANTAO J 2006; 4(2): 21-24. 8. Mydlík M, Derzsiová K. Liver and kidney damage in acute poisoning. BANTAO J 2006; 4(1): 30-33. 9. Mydlík M, Derzsiová K. Metabolic disorders of vitamin B6 in chronic kidney disease patients. BANTAO J 2009; 7(2): 33- 36 . 10. Mydlík M, Derzsiová K, Šebeková K, Farkaš M, Hvozdovičová B, Chmelárová A. Advanced glycation end-products (AGEs) and long-distance run. BANTAO J 2011; 9: 67-71. 11. Mydlik M, Derzsiova K, Čislak I. Chronic Glomerulonephritis and Pregnancy BANTAO J 2008; 6(1): 24–26. 12. Nenov Dimitar. Bull Eur Assoc Profs Emer 2020; 1(S1): 150-151.
An Account of the Celebration Day held in Honour of Stewart’s Life and Work.“Stewart Cameron. A Very Great Nephrologist” This celebration, held at Guy’s Hospital on 19th April 2024 was attended by about 100 people, including members of Stewart’s family. It was recorded throughout and is available on “YouTube”. Stewart trained at Guy’s (1953-1959) and was appointed Professor of Renal Medicine in 1974. He “retired” in 1995 becoming Emeritus Professor. He died on 30th July 2023. The Celebration Day The day was introduced and co-chaired by Ian Abbs, Nephrologist at Guy’s and now Chief Executive of Guy’s and St Thomas’s NHS Trust. The organiser and co-chairman was Professor John Feehally, Emeritus Professor of Renal Medicine, University of Leicester. Proceedings were in 4 sessions with 15 presenters. In this account I have used names without titles or affiliations as in the Programme of the Day and for brevity. (Fig 2 and Fig 3)
Janusz Ostrowski
PROFESSOR JOHN STEWART CAMERON, MD, FRCP, CBE 1934-2023
Consultant Nephrologist (retired) Charing Cross Hospital, London malcolm.phillips101@gmail.com
Dr Malcolm Phillips
Maria Kalientzidou Katarina Derzsiova Vincenzo Savica
Murat Aksu Abdullah Yildiz Mario Lamagna
Councillors:
Speakers: Aciduman A (Türkiye) Aksu M (Türkiye) Ardaillou R (France) Balat Ayse (Türkiye) Bisaccia C (Italy) Credendino O (Italy) De Santo NG (Italy) De Santo MR (Italy) Derzsiovà K (Slovakia) Diamandopoulos A (Greece) Gembillo G (Italy) Gigliotti G (Italy) Kalientzidou M (Greece)
Koulouridis Efstathios (Greece) Kurkus J (Poland/Sweden) Lamagna M (Italy) Mussi D (Italy) Ostrowski J (Poland) Philips M (UK) Rutkowski B (Poland) Savica V (Italy) Stefanidis I (Greece) Viggiano D (Italy) Widmer D (USA) Yildiz A (Türkiye)
Faculty: Bellinghieri G (Italy) Iorio L (Italy) Eknoyan G (USA) Calò L (Italy) Kazancioglu R (Türkiye) Ricciardi B (Italy) San Ayla (Türkiye) Smogorzewski M (Poland/USA) Mezzogiorno A (Italy)
Scientific secretary: for information email to davide.viggiano@unicampania.it Organizing secretariat: Galileo Eventi - email: galileoeventi@gmail.com The program of the event will be posted on the IAHN website and the Galileo Eventi website: https://www.iahn.info https://www.galileoeventi.it Davide Viggiano Congress President
Professor Zbylut Twardowski
Professor Zbylut Twardowski was born on 2 June 1934 in Stanisławice, Poland. He began his education during the Second World War. He passed his secondary school leaving examinations with honours in Chorzów Batory in 1952 and in the same year commenced medical studies at the Faculty of Medicine of the Medical Academy in Krakow, which he completed with honours in January 1959. In July 1959, he started working at the Emergency Station in Krakow and as a volunteer assistant at the 2nd Clinic of Internal Medicine at the Medical Academy in Krakow, where he took part in the organisation of the Dialysis Centre of the Clinic. In 1962, he was employed there as an assistant. In 1963, he moved to the Mining Hospital in Bytom, where within a year he organised the 4th Department of Internal Medicine including the Dialysis Centre. In 1963 he obtained his first degree of specialisation in internal medicine. In 1964 he was awarded the degree of Doctor of Medicine on the basis of his thesis "On the advantages and possibility of constructing an artificial capillary kidney". In the autumn of 1966, he obtained his second degree of specialisation in internal medicine. In the same year became a member of the Transplantation Commission of the Ministry of Health and Welfare. In 1968, he became head of the Department of Internal Medicine in the Mining Hospital in Bytom. In 1969 spent 3 weeks in the UK, where he
visited several nephrology centres. In 1972 he did a month's internship at the Medical Renal Unit, Royal Infirmary, University of Edinburgh, Scotland. In 1974, he visited several dialysis centres in northern Italy, including Bologna, Padua and Milan. In 1975, he successfully defended his habilitation thesis entitled: "On the adequacy of haemodialysis in the treatment of chronic renal. failure". From September 1976 to August 1977 he worked as a fellow in the Division of Nephrology, Department of Medicine, University of Missouri, Columbia, Missouri. In September 1977, he moved to Lublin, where he became Head of the Department of Nephrology, Institute of Internal Medicine, Medical Academy, in 1978. In the same year, he became a member of the Commission for the Development of Dialysis and Transplantation of the Ministry of Health and Welfare and the Nephrology Commission of the Polish Academy of Sciences In July 1981, he again left for the United States and took up a post as Research Fellow at the Division of Nephrology, Department of Medicine, University of Missouri, Columbia, Missouri. Here, the Professor was found by the martial law introduced in Poland. In 1982, he was employed as Visiting Associate Professor at the Department of Medicine, University of Missouri. In 1985, he was promoted to Professor in the Department of Medicine of this University and Director of the Peritoneal Dialysis Clinic in the Division of Nephrology. From 1983, he took up the position of Staff Physician in Nephrology, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri. In 1987, he was promoted to a permanent professorship (Professor with tenure in the Department of Medicine, University of Missouri). From 1991 -1999, he worked as an Investigator at the Dalton Research Center, University of Missouri, Columbia, Missouri. He retired in 1999 and received the privileges of Professor Emeritus of Medicine at the same University. He has worked closely with great figures in nephrology, including Karl Nolph and others. Professor Twardowski's main clinical interests and achievements, carried out initially in Poland and later in the United States, were connected with renal replacement therapy, particularly peritoneal dialysis and haemodialysis. At the beginning of his career, he was also interested in problems of kidney transplantation, including those from living donors. As early as 1964, he patented a capillary dialyser in Poland, and in 1965 an improved version. This was the first patent in the world in this field. Unfortunately, it was not possible to manufacture such a dialyser in Poland, but this was done somewhat later by American constructors. This type of dialyser is now in widespread used throughout the world. Further patents related to swan neck catheters for peritoneal dialysis, presternal catheters for peritoneal dialysis, new types of haemodialysis catheters resistant to clot formation, as well as machines for daily home haemodialysis. In total, he has patented 23 solutions for renal replacement therapy in Poland, the United States and other countries around the world, including all European countries. He was also involved in describing a new method of peritoneal dialysis, the continuous ambulatory peritoneal dialysis (CAPD), the peritoneal equilibration test (PET), which is still used in every peritoneal dialysis centre in the world, was one of the first to propose more frequent and longer haemodialysis, and a specific type of arteriovenous fistula puncture called butonholes. He was also the author of 180 abstracts, nearly 400 articles and book chapters, 7 teaching videos, and 24 letters to editors. He presented 500 lectures at scientific conferences and was chairman of approximately 100 scientific sessions. Professor Zbylut Twardowski was a member of many scientific societies around the world. These included, in particular, membership of the Polish Medical Association, Polish Society of Internal Medicine, European Renal Association-European Dialysis and Transplant Association, International Society of Nephrology, Polish Society of Nephrology (honorary member), American Medical Association, American College of Physicians, American Society of Artificial Internal Organs, Member, International Society for Peritoneal Dialysis, American Society of Nephrology, Colombian Society of Nephrology (honorary member), International Society for Hemodialysis and International Society for Hemodialysis. He was also founding editor of Hemodialysis International, editor in Chief of Hemodialysis International, Associate Editor Peritoneal Dialysis International, Associate Editor of Advances in Peritoneal Dialysis, Editor of Hemodialysis Today, and also Associate Editor Peritoneal Dialysis Today in the years 1985 - 2001. He received numerous awards and honours for his exceptionally active work and scientific achievements. These include the American Kidney Fund Torchbearer Award, Best Doctors in America, Who's Who in the World, silver medal of the Polish Society of Pediatric Nephrology, Medicus sapiens renes sani liberi ridentes", International Society for Haemodialysis Belding H. Scribner Trailblazer Award, 2004 Lifetime Achievement Award of the National Kidney Foundation, honorary membership of the Polish Society of Nephrology (2009) and many others. Professor Zbylut Twardowski achieved his first greatest successes in Poland during a very difficult economic and political situation, before the ‘Iron Curtain’ was broken down and later on also in the United States, where he continued his extremely fruitful clinical and scientific career. This was characterised by a drive to discover new possibilities in renal replacement therapy and to improve these pursuits. All his activities were directed towards improving the effectiveness of treatment and the welfare of patients with chronic kidney disease. Many of his insights and predictions are still relevant today around the world, including Europe, therefore Professor Zbylut Twardowski can be considered as one of the leaders in the development of renal replacement therapy, particularly dialysis therapy. The death of Professor Zbylut Twardowski is a great loss to the entire nephrology community worldwide. Andrzej Więcek (ERA Past-President) Janusz Ostrowski (IAHN Past-President)
Photo Janusz Ostrowski, Exhibition ERA-EDTA Congress 2010
Janusz Ostrowski
PROFESSOR ZBYLUT JÓZEF TWARDOWSKI (1934-2024). IN MEMORIAM.
1 Head of the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland 2 Professor, Department of the History of Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
Andrzej Więcek 1 , Janusz Ostrowski 2
Luigi Iorio, Division of Nephrology, De Bosis Hospital, Cassino: Conferences on Kidney Failure and Heart Failure
Nicola De Napoli, Teresa Papalia, Division of Nephrology, Annunziata Hospital Cosenza: Telesio Conferences on Edema, Sister Program of the International Society of Nephrology
Guido Bellinghieri and Vincenzo Savica, Division of Nephrology University of Messina: Taormina course, Mediterranean Kidney Society, International Federation of Kidney Foundations
Natale Gaspare De Santo, Giovanbattista Capasso, Massimo Cirillo, 7th European Colloquium on Renal Physiology, Borelli Conferences on Acid-Base Balance, Visiting Professor of the University Luigi Vanvitelli, Conferences of the Italian Institute of Philosophical Studies on Human Clinical Research: Ethics and Economics (1997) and Survival is Not Enough (2007-2020), Bulgarian Assocaition of Professors Emeriti (2020)
The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) Professor Nenov was one of the key persons that made possible The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO). BANTAO (Figure2) Connects Nephrologists from the Balkan Cities not Balkan Countries. The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was established in Ohrid, Republic of North Macedonia on October 9, 1993. (Figure 3)
Janusz Ostrowski
PROFESSOR DIMITAR NENOV (1933 – 2024). THE FOUNDER OF THE BANTAO JOURNAL
Former Head of the Nephrological Laboratory IV th Internal Clinic University Hospital of L. Pasteur, Košice, Slovak Republic
Dipl. Ing. Katarina Derzsiova
Professor Dimitar Nenov retired in 2001 after a prolific 44-year career. His scientific and organisational activities did not cease. During the following years of his life, he continued to organise annual educational courses - seminars in nephrology under the title, "Hot Topics in Nephrology" with the participation of leading national and international experts. He also set up a small private holiday haemodialysis centre which operated every summer and provided regular dialysis treatment to dialysis patients, especially those from abroad. This enabled them to holiday in nearby seaside resorts during the summer holidays (12). This opportunity was also offered to our dialysis patients. As a member of the editorial board of the BANTAO Journal and a member of the International Federation of Kidney Foundations, he became Professor Emeritus. Later, Professor Nenov, together with ten other professors representing five universities in Varna, was the founder of the Bulgarian Association of Emeritus Professors and was elected its President. Professor Dimitar Nenov, always smiling, good-tempered, very friendly, and pleasantly talkative, will be missed not only by Bulgarian nephrologists, nephrologists of the whole Balkan Peninsula, but also by many nephrologists from all over the world and, finally, by myself. (Fig 4.) . His life's journey is over, our friend Dimitar left. Honor to his memory. Katarina Derzsiova
Stewart Cameron
Stewart Cameron
Stewart the Clinician John Feehally: Stewart the Nephrologist John recalled how Stewart, as Professor, built up the Renal Department from when appointed Professor. From the start he promoted the concept of a “renal family”, incorporating all staff involved in the care of renal patients, and, most importantly, the patients themselves. He devoted himself to clinical and scientific nephrology. Dialysis of patients with chronic renal failure (CRF) was started and he recognised the need for an active renal transplant programme. Care of children with renal diseases was commenced. He had earlier spent a year at Cornell University (1962-63) researching proteinuria/selectivity, and there first encountered dialysis and transplantation for End-Stage Renal Failure (ESRF). His interest in glomerular diseases led to his becoming a leading authority on glomerulonephritis (GN). John referred to Stewart’s wide-ranging contributions to nephrology, including paediatric nephrology, lupus, urate metabolism and the history of nephrology. He trained over 250 juniors and fellows from all over the world; many became senior figures in the specialty and other areas of medicine. Chisholm Ogg: Working with Stewart It was a delight to listen to Stewart’s closest-working colleague for nearly 30 years and a friendship extending over 50 years. Chisholm was instrumental, with Stewart, in developing the Guy’s renal centre including paediatric nephrology. He recounted weekly meetings with other specialties: radiology, nuclear medicine, pathology and paediatrics-all examples of the “renal family” concept which permeated the service and contributed so much to its success and fame. Chisholm amusingly described the initial, limited dialysis facilities followed by the subsequent expansion involving adult and child dialysis and the start. of transplantation. Diana Sale, Penny Powis: Stewart and the Renal Family The meeting would have been incomplete without hearing from senior nursing staff who worked on the renal unit. The theme of the renal family came across strongly, both clinically and personally. It was clear from both that nurses “ran the dialysis unit”, carrying out what were, at that time, considered non-nursing procedures (as well as social activities!). Such actions were frowned upon by the Guy’s nursing hierarchy! But importantly, “everyone’s opinion was valued” and “patients were partners in their care”. Through the nursing team the first nurse-training course in dialysis in the UK was created. Geoff Koffman: Stewart and Kidney Transplantation Geoff gave an illuminating review of transplantation at Guy’s in which he had played a significant role as transplant surgeon. Transplantation started in 1966. In the first 5 years about 200 operations were performed. In 1968 the first transplant of a child occurred leading to the establishment of the first children’s dialysis and transplant unit in the UK. Transplantation grew rapidly. There are now 11 transplant surgeons at Guy’s carrying out approximately 300 transplants /year. Live donor transplantation was promoted, increasing from 5-10 per annum to over 100. In 1995 a kidney-pancreas transplant programme for diabetics was successfully introduced. Stewart’s role in transplantation was prominent, particularly promoting low-dose steroids and transplantation of elderly patients with ESRF. Cyril Chantler: Stewart and Paediatric Nephrology Stewart was significantly involved in the early phase of paediatric nephrology, introducing it soon after he became Professor. By 1970, 11 children had been treated by dialysis /transplantation. Stewart wrote his first paediatric paper in 1971. His role in this area led to him being made President of the European Society of Paediatric Nephrology (1975). Both Cyril and Stewart focused closely on adolescents, emphasising the need for attention to treatment at this stage in a child’s development. I cannot but include some amusing stories involving Stewart. Cyril recalled a conversation with an eminent, older consultant who stated how lucky it was to have Stewart on the staff and how intelligent he was. Cyril concurred. “It’s just a pity he doesn’t wear the uniform” was the next comment! Stewart’s dress code was often referred to during the Celebration Day with affection and laughter. Stewart the Investigator Richard Glassock: Stewart and Glomerular Disease-the Early Years Richard, appearing by video-link from California referred to Stewart’s first papers: in J. Clin Invest (1964) - proteinuria in the nephrotic syndrome (NS), Lancet (1965) - proteinuria in children with NS and the BMJ (1966) - treatment of proliferative nephritis and NS. Other papers followed in the BMJ signalling that Stewart was in the forefront of work in glomerular disease. Richard followed Stewart’s career with great interest and in 1988 they jointly wrote a book on NS which is still quoted today. Richard and Stewart were firm friends. We will remember Richard’s parting words in his talk, translated from Gaelic:“Farewell my friend, until we meet again”. Andy Rees: Stewart and Glomerular Disease-After That Andy recounted his first “out-of-the-blue” meeting with Stewart which occurred with less than 24 hours’ notice from Andy. He was appointed at Guy’s a few months later, though he did not attribute that to Stewart’s influence but partly because he was wearing his only suit! Andy regarded Stewart as being responsible for nephrology “moving on” from primitive descriptions of GN such as “Ellis types I and II”, and minimal-change GN (MCGN) being early membranous GN having a 50% mortality without steroid treatment. Stewart reclassified GN initially with data on MCGN, membranous GN and proliferative GN in adults and children. Later classifications by Stewart were even more detailed. Stewart was the first to use Venn diagrams in nephrology and introduced actuarial survival curves in various forms of GN, -work of international renown. He showed that survival in NS was directly related to the degree of proteinuria -a finding confirmed ever since. He published studies on complement, platelet activation and glomerular macrophages and T-cell substrates in GN. Much of this data lead to the testing of new therapies. Liz Lightstone: Stewart and Lupus Liz started her talk (by video) indicating that Stewart published extensively on lupus nephritis (LN). He had stressed the importance of using low-dose steroids in lupus because of the morbidity and mortality associated with high-doses. His work also showed the necessity of long-term follow-up of patients, the importance of lupus in relation to pregnancy and the need for randomised controlled trials in its treatment. In a Lancet paper (1970) he wrote on the steroid-saving effect of cyclophosphamide in LN. He challenged the view that LN was a benign disorder pointing out the published high mortality rates. But in 1999 he reported long-term results in 116 patients treated at Guy’s with low-dose steroids and azathioprine, showing improved survival. Stewart also published significant data on childhood lupus. Stewart the Influencer Chris Winearls: Stewart the UK Leader Chris described organisational events occurring before the International Society of Nephrology (ISN) congress in 1993 with Stewart as President. Chris was a secretarial helper, or, as he put it, “a bag-carrier”! Stewart overcame major these problems with great expertise. The meeting was a success and significantly enhanced the standing of UK nephrology in the eyes of the wider world. As President of the UK Renal Association (1992-1995) Stewart fought for greater funding for renal services. The recognition of his major position in nephrology contributed to success. By retirement he had “made UK nephrology respectable” as well as being recognised as a world-leader in the specialty. Pierre Ronco-Stewart in European Nephrology In his absence John Feehally presented using Pierre’s slides. Pierre noted that Stewart was a delegate at the founding meeting of the ERA-EDTA (1964). He was editor of the Proceedings of its congresses 1970-1973. From 1984-1987 he was President and in 1985 was involved in creating “Nephrology, Dialysis and Transplantation”; he was a member of the journal’s Editorial Board 1986-1993. One of Pierre’s slides struck home. He quoted Stewart stating that both the science and the clinical practice of nephrology were vital. In a cautionary frame of mind, Stewart added “There are good scientists among young doctors, but are they shaking the hands of patients at midnight?”-A message for Europe and beyond. Jo Adu: Stewart and the Development of Global Nephrology Jo began (by video) describing the Guy’s unit as a “United Nations of doctors and scientists” referring to the number and range of nationalities in the team. He described changes within the ISN to spread its messages to the developing world. As President of the ISN, Stewart was committed to global development and the Committee for the Global Advancement of Nephrology was established subsequently. This led to developments such as the Fellowship Training Programme and the Sister Renal Center Programme, among others. From 2001 nephrology flowered in Africa, the Middle East and Asia. Now, the ISN features in 153 countries and has over 9000 members. Stewart’s view that ISN should spread nephrology world-wide is now a reality. Leon Fine: Stewart the Writer and Historian It is pertinent to report here that Leon (by video from US) described Stewart as “the most prominent member of the IAHN”, and “he was the history of nephrology” writing over 50 papers on this topic. He helped establish a series of in- depth, recorded interviews with prominent, but retired, nephrologists which led to the formation of this Association. In 2013 his contributions in this field were recognised with Honorary Membership of IAHN. Ian Abbs: Stewart’s Impact through Guy’s High praise when Ian stated that Stewart “with others, paved the path for the future of Guy’s”. The multi-professional team model contributed to this. He helped to change a rigid hierarchical period in which creativity was frowned on to the “foundational” period of the 70’s. The multi-disciplinary team approach was more-or-less an innovation in British medicine. Patient’s needs were put first. Here I digress again into an amusing story from Ian’s personal experience. On a ward round Ian presented the case of a lady with interstitial nephritis the cause of which had eluded him. He felt that Stewart was not listening. But Stewart picked up the patient’s handbag and started rummaging through it! After a while Stewart held up some pills-the patient called them her “little helpers”. “Are they by any chance called Naproxen?” Stewart asked. They were! Aetiology solved! Where are We Now? Sharlene Greenwood: Multi-Professional Care in 2004 Sharlene, Renal Physiotherapist- a profession not heard of by many in the audience, but clearly another branch of the “renal family”. Sharlene stressed the need for clinicians to address all of a patient’s needs. She described the establishment of the Renal Services Transformation Programme- a multi-professional workforce formed in2020, including counsellors, physiotherapists, occupational therapists and renal psychologists. Recruitment to these positions is occurring gradually. Sharlene recognised the early contribution to this concept made by Stewart and his team. Neil Turner: Nephrology in 2024 Neil showed data from the 1960’s to recently on the global numbers of patients on dialysis and those with functioning transplants. Whilst numbers of dialysis patients have more-or-less plateaued, transplant numbers have risen substantially and continue to do so. In terms of current focus on renal diseases Neil outlined work in 1979 on 2500 patients with glomerular disease, including data from Guy’s, on the relationship of the degree of proteinuria in relation to kidney survival. This year a paper with data on over 12,000 patients from renal registries world-wide showed that glomerular disease is still a major cause of loss of kidney function and that the degree of proteinuria still relates to survival of kidney function. Treatment with ACE inhibitors, Angiotensin II receptor antagonists and more recently aldosterone antagonists may be beneficial to many patients otherwise heading towards ESRF. Ian Abbs, Cyril Chantler, John Feehally: Summing Up Between them, tribute was paid to the support received from Guy’s, Kings and the UK Kidney Association and particularly to John for his planning and organisational work, in making this Celebration of Stewart’s life and achievements possible. It had been a truly inspirational, happy and fitting event, ending with old friends being invited to meet in the bar in true “Stewart style”. I can do no better than to end with a quotation from Stewart himself: “Friendship should remain as a primary value, as friendship is important in every human endeavour” INFO FROM POLAND As in previous issues of the IAHN Bulletin, I am providing a brief update on the most important nephrology events that took place in Poland in the first half of 2024. The first of these was the Gdańsk Nephrology Review POST ASN Meeting, which has been held for 20 years. It took place on January 12-13. Janusz Ostrowski delivered a lecture titled "The History of Urine Examination" (Figures 1, 2).
Announcement: XIII IAHN Meeting, Naples Dear Distinguished Colleagues, We are pleased to inform you that the XIII Congress of the International Association for the History of Nephrology (IAHN) will be held in Naples, Italy. To ensure a smooth event experience, the meeting dates have been shifted to Friday, November 15th - Sunday, November 17th, 2024. This marks a significant homecoming for IAHN. In 1993, Italy (Cassino) hosted the inaugural congress, laying the foundation for a vibrant field. Thirty years later, a wealth of data has been collected, with over 500 original manuscripts published in international journals. The Congress celebrates the remarkable progress of nephrology, in the boundary zones of other disciplines and its entry into scientific parlance in the 1950s of the twentieth century, yet with roots extending well beyond the work of Thomas Addis. Fueled by advancements like dialysis, it has rapidly evolved to address the needs of millions worldwide. The 2024 IAHN meeting delves into the fascinating history of kidney disease treatments, offering a unique perspective on the latest therapeutic breakthroughs. This will allow us to better understand the latest therapeutical advances (such as HIF inhibitors, new drugs for IgA, MCO filters, glyflozins, new mineralocorticoid antagonists, new CNI, anti-Bliss, etc.) from a historical perspective. This exploration will inspire new historical inquiries and a deeper understanding of contemporary treatments. Join us in celebrating the History of Nephrology in Italy. Network face-to-face with prestigious Italian and international researchers in the field, fostering collaboration and sparking new research ideas. The congress will feature captivating plenary lectures by prominent Italian and global experts, encouraging active participation from young scientists. Don't miss this opportunity to connect, celebrate, and propel the future of nephrology history! Venue: Camaldoli Hermitage, Naples. From the airport to the Hermitage, it takes less than 30 minutes by car or taxi.
Figure 1. Professor Boleslaw Rutkowski, main organizer (photo Janusz Ostrowski)
Figure 2. Professor Janusz Ostrowski (photo Maria Ostrowska)
Another important event was the conference related to the World Kidney Day traditionally organised by Prof. Ryszard Gellert on March 15. Przemysław Rutkowski and Janusz Ostrowski also actively participated in this meeting (Figures 3, 4).
Figure 3. Professor Janusz Ostrowski
Figure 4. From left: Professors Przemysław Rutkowski, Janusz Ostrowski, Ryszard Gellert
Next was the Scientific and Training Conference "Nephrocardiology 2024" held on April 19-20 in Białystok, where Bolesław Rutkowski and Janusz Ostrowski demonstrated their active participation (Figures 5, 6).
Figure 5. Professor Bolesław Rutkowski. (photo. Janusz Ostrowski)
Figure 6. Professor Janusz Ostrowski. First right. (photo. Maria Ostrowska)
On May 8th, I participated in a joint scientific session organised by one of the oldest scientific societies in Poland, the Krakow Medical Society, together with the Krakow Society of Medical History Enthusiasts. During this session, I presented a lecture titled "Professor Zbylut Twardowski's Contribution to the Development of Nephrology" (Figures 7, 8).
Figure 7. Professor Janusz Ostrowski (photo Maria Ostrowska)
Figure 8. From left: dr Adam Wiernikowski, prof. Władysław Sułowicz, dr Halina Twardowska, prof. Janusz Ostrowski (photo Maria Ostrowska)
The last event in the period concerned was the XXVIII Scientific and Training Conference of the Polish Society of Nephrology, with active participation of some members of the IAHN including Bolesław Rutkowski, Przemysław Rutkowski, and myself. During the General Assembly of the Polish Society of Nephrology, I was honoured with the title of an honorary member of the Society (Figures 9, 10).               Janusz Ostrowski
Figure 9. Professor Bolesław Rutkowski (photo Janusz Ostrowski)
Figure 10. Professor Janusz Ostrowski, first left (photo Leszek Domański)
OBITUARIES
Janusz Ostrowski
INFORMATION ABOUT NEXT IAHN CONGRESS
Department of Translational Medical Sciences, Univ. of Campania “L. Vanvitelli”, Naples, Italy
Davide Viggiano
The establishment of the BANTAO Journal was a milestone in the life of BANTAO, which was launched in 2003 in Varna at the 6th BANTAO Congress. The BANTAO Journal represents the main link, the glue connecting all the Association members. It is currently published twice a year. Dimitar Nenov was its first editor-in-chief (2). Professor Mydlík took part in the inaugural ceremony of the BANTAO Journal, which has made its mark in the history of the Balkan Peninsula. Professor Mydlík immediately seized the opportunity to publish in this incipient journal. Two of our papers presented at the 2003 BANTAO Congress were published in the same year (4,5). The number of our publications increased thanks to the consistent assistance of the journal editors (Momir Polenaković, Goce Spasovski, Ali Basci, and others). We published a total of eight papers in the BANTAO Journal (4-11) and contributed six presentations at BANTAO congresses in the same years. Dimitar Nenov had the idea of establishing a National Bulgarian Nephrology Journal, which would be free of language barrier for Bulgarian nephrologists. He implemented his idea, founding the journal Aktualna Nefrologia as an experiment to see if it would flourish or die out. The journal was a success and Nenov was not just the founder but also the editor-in- chief of the journal. In 1991, at his initiative, the Varna Kidney Foundation was established. In addition, he was a founder of the International Federation of Kidney Foundations (IFKF). Our friendship with Professor Nenov has been a tradition since the last decade of the last century. We met most often in Sicily at the Nephrology Courses in Taormina , organized by Professors Guido Bellinghieri and Vincenzo Savica. Professor Nenov, Professor Mydlík and later I, were regular lecturers. In that pleasant environment and company, our friendship was strengthened especially thanks to the opportunity to talk in the common Czech-Slovak language. Professor Nenov was fluent in Czech. He learned Czech in 1966 during a stay in Prague at the Institute for Blood Circulation Diseases, which at that time was headed by Professor Jan Brod, the doyen of nephrology in Czechoslovakia. In 2006, Professor Mydlík invited Dimitar Nenov to Košice to the 7th International Nephrology Symposium " Metabolic Changes in Chronic Renal Failure ", which was held on awarding the honorary degree of "Doctor Honoris Causa" to Professor Vittorio Bonomini, M.D., from the University of Bologna, Italy. The ceremony took place in the Historical Auditorium of the P. J. Šafárik University in Košice, at Rector's Office. The following day, the Symposium was held in the Historical Hall of the East Slovak Gallery, where Professor Nenov presented his scientific work on the topic, "Hepatitis C in Haemodialysis Patients ". Other lectures were given by eminent nephrologists from Slovakia and Europe, three of them, Professors Guido Bellinghieri, František Kokot, and Vittorio Bonomoni, were Doctor Honoris Causa of our University. Professor Nenov also took part in the social programme during that festive event, the " Chamber Music in the St. Michael Chapel", the "Sightseeing Tour in the Historical Part of Košice”, and the farewell dinner hosted by the celebrant, Professor Bonomini, and his son. At the end of his stay, Dimitar Nenov visited "Nephron" , our private Dialysis Centre in Košice (Fig. 3.).
I had met him together in the 90s through mutual friends Vincenzo Savica, Natale De Santo and Shaul Massry during a scientific meeting in Varna and an affectionate friendship was immediately born. Dimitar was a special person, he was a great gentleman, he had the character traits typical of a Bulgar man, very reserved, generous, sincere and above all very dignified with a keen intelligence. Thanks to the friendship that was immediately established, I had, at his invitation, the opportunity to visit Bulgaria and in particular the beautiful city of Varna. during the annual scientific meetings organized by him on behalf of the Bulgarian Kidney Foundation entitled "Hot topics in Nephrology". By virtue of his interest in Sicily, I had the opportunity to invite him to participate in the international nephrological scientific meetings in Taormina, conferences which saw his active participation with a lecture in 1998 during the V Taormina (Fig. 1)
Janusz Ostrowski
DIMITAR NENOV IN SICILY (1998-2009)
President of the Italian Branch of European Association of Professors Emeriti, National Councilor of Italian Association of Organs Tissues and Cells Donors, Founder of the Mediterranean Kidney Society Email: gbellinghieri@hotmail.com
Guido Bellinghieri
Proceedings of 5 th Toarmina Course on Nephrology 1998
Course on Nephrology entitled "Familial Hyperlipidemia Treatment with Monoclonal LDL-Apheresis" (1). Also interesting was the lecture on "Fluid and electrolyte balance in the elderly" which he then gave in 2000 (Fig. 2, 3) during the VI Taormina Course on Nephrology (2).
VI Taormina course on Nephrology 22 October 2000
He also took an active part in Taormina during the 3rd congress of the International Association for the History of Nephrology (IAHN) in November 2001 (Fig. 4.). In that occasion he delivere a lecture on “Balkan Nephropathy A Disorder of Renal Embryogenesis ? “ (3).
3 rd congress of the International Association for the History of Nephrology Taormina 2001
His other interesting interventions saw him involved both during the VII Congress of the International F e d e r a t i o n s o f Kidney Foundation (IFKF) in 2006 in Giardini Naxos and during the I congress of the Mediterranean Kidney Society (MKS) held in October 2009 in Taormina (Fig. 5, 6).
I st Mediterranean Kidney Society Congress Taormina October 2009
I st Mediterranean Kidney Society Congress Taormina October 2009
6 th Taormina Course on Nephrology 2000
His active participation in the aforementioned scientific meetings was always punctual and precise and derived from his vast scientific and healthcare knowledge in the nephrology field. His passing will deprive us of his smile, his elegance in presenting himself and the human warmth he was able to convey to those who were lucky enough to enjoy his friendship. For these reasons, dear Dimitar, you will always remain present in our memory. References: 1. Nenov D, Stoyanov A, Tchankova P., Konovalov G.: Familial Hyperlipidemia with Monoclonal LDL-Apheresis. Proceedings of 5th Taormina Course on Nephrology. Ed. Bios 1998: 275-279. 2. Todorova V.S., Nenov V. D., Nenov D. S.: Fluid and Electrolyte Balance in the Elderly Proceedings of 6th Taormina Course on Nephrology. Ed. Bios 2000.: 99-105. 3. Nenov V. D., . Nenov D. S: “Balkan Nephropathy. A Disorder of Renal Embryogenesis? Am. J. Nephrol. 2002; 22: 260-265.