Ciba Foundation Symposium - The Kidney: Arranged Jointly with the Renal Association

358 Pages·1954·16.07 MB·English

THE KIDNEY
General Volumes:
Toxaemias of Pregnancy . . . . . . . 21s.
Isotopes in Biochemistry . . . . . . 27s. 6d.
Visceral Circulation . . . . . . . . . 30s.
The Spinal Cord . . . . . . . . . . 30s.
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1
Hypertension: Neurogenic and Humoral Ready
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.I leaflet gicing fuller details of lhrse volumes, also of the C'iba Fouzdalion
Colloquia on Endocrinology, is arailablefrom the Publishers.
CIBA FOUNDATION SYMPOSIUM
ON
THE KIDNEY
Arranged jointly with the
Renal Association
Editor for the Retial Assoeialiori
A. A. G. LEWIS, B.Sc., M.D., M.R.C.P.
Editol. for the Ciba Foundatiota
G. E. w. WOLSTENHOLME, O.B.E., M.A., hI.B., B.Ch.
Assisted by
JOAN ETHERINGTON
LONDON
J. & A. CHURCHILL LTD.
104 GLOUCESTER PLACE, W.l
1954
THE CIBA FOUNDATION
for the Promotion of International Co-operation in Medical and Chemical Research
41 PORTLANr) PLACE, LONDONw, .1
Trimtees :
DR. E. D. ADRIAN, P.R.S.
OM.,
RIGHTH ON. LORDB EVERIDGEK,. C.B., F.R.4.
THE
THE RIGHTH ON. LORD HORDERG, .C.V.0.
MR. RAYMOND NEEDHAM, Q.C.
Director, and Secretary to the Executive Council:
DR. G. E. w. \vOIaSTENIIOLME. 0.R.E.
:lssistarit Secretary:
MISS s. BLAND
Scientijc Assistant mid Lihrariati .
MISS M. P. CAMERON,M A.
Editorial Assistant:
AIlSS JOANE THERINGTON
ALL RIGHTSR ESERVED
This book may not be reproduced by'
anu means, in whole or in part, with-
out tlte permission of the Publish,ers
Printed in Great Britain
PREFACE
THEC iba Foundation is an international centre, established
as an educational and scientific charity under the laws of
England. It owes its inception and support to its founder,
Ciba Limited of Switzerland, but is administered exclusively
by its distinguished British Trustees.
As one part of the Foundation’s activities, informal
symposia or colloquia, strictly limited in membership, are
arranged, to which leading research workers from different
countries and different disciplines are invited. As the small-
ness of the group necessarily excludes many people active
and interested in the subjects discussed, the proceedings
are being published and made available throughout the
world.
“The Kidney” was arranged at the request and with the
assistance of the Executive Committee of the Renal Associa-
tion. It was initiated mainly by Mr. G. J. Sophian, formerly
Hon. Secretary of the Association, and considerable help was
given to the Director of the Foundation in planning the
programme and selecting the membership by Dr. C. E. Dent,
Prof. K. J. Franklin, Dr. A. A. G. Lewis (Hon. Secretary) and
Dr. W. W. Payne.
The ground covered at this symposium included structural
and functional relationships in the kidney, the regulation of
acid-base balance, tubular functions other than the regulation
of acid-base balance, general problems of electrolyte excretion,
and the renal share in the volume control of body fluid.
As membership was severely limited and, apart from many
workers in the field in other countries, the great majority of
the members of the Renal Association had to be excluded, a
public session was held at the Royal Society of Medicine on
the day after the conclusion of the symposium at which Dr.
Jean Oliver, Dr. J. V. Taggart, Dr. R. F. Pitts, Dr. N. Alwall,
V
vi PREFACE
and Prof. J. G. G. Borst reviewed in turn the proceedings of
the five sessions of the symposium. A report of this public
meeting was published in The Lancet Vol. 11, page 120).
(1953,
It is hoped that the full proceedings of the symposium
recorded in this book will prove not only informative and
stimulating, but will also give to readers a sense of participa-
tion in this informal and friendly occasion.
The Editors are greatly indebted to Mr. J. and Rlr. John A.
Rivers of Messrs. J. & A. Churchill, Ltd., for their courteous
attention and ready advice at all stages of the preparation
of this volume.
FOREWORD
A. A. OSMAN,D .s.c., M.D., F.H.C.P.
THIS book embodies a verbatim account of the proceedings
at an international symposium on The Kidney arranged
jointly by the Ciba Foundation and the Renal Association,
and held in London from the 7th to the loth July,
1953.
To facilitate a free, informal and intimate exchange of
views membership was limited to thirty-five participants,
but the last day of the conference was devoted to a review
of the previous sessions by five of the participants. This
meeting, at the Royal Society of Medicine, was made open
to the Profession and was very well attended.
The participating members were chosen for their eminence
in those aspects of renal anatomy, physiology, pathology and
medicine that it was desired to integrate for study, and
included experts not only from this country but also from
Belgium, Denmark, France, Holland, Sweden, Switzerland
and the U.S.A.
Twenty-two papers were read and each was followed by a
full, and often vigorous, discussion under a number of dis-
tinguished Chairmen.
No one who was privileged to attend this Symposium
would, I am sure, regard it as having been other than a most
stimulating and rewarding, if somewhat strenuous, experience,
and it was generally felt that the mass of valuable information
presented, together with the illuminating comments made in
the subsequent discussions, should be permanently recorded
and made more widely available.
That this volume will prove valuable to all interested in the
kidney and its disorders can hardly be doubted, and is, I
know, the earnest hope of the Editor for the Foundation,
to whom, incidentally, credit for the success of the whole
venture is chiefly due.
vii
CONTENTS
PAGE
Foreword by
A. A. OSMAND, SC, MD, FRCP (Physician-in-charge, The Renal
Unit, Pembury Hospital; President of the Renal Association) vii
Part I-Structural and Functional Relationships in
the Kidney
Chairman: PROFESSDOORR OTHYRU SSELLS,C D, MD, FRCP, LLD
(Bernhard Baron Institute of Pathology, London
Hospital, London)
The structural and functional aspects of recovery from
acute renal failure
J. OLIVERM, D (Dept. of Pathology, N.Y. State University;
now at Renal Research Unit, Overlook Hospital, Summit,
New Jersey) .
1
Discussion
D. A. K. BLACK,S . E. BRADLEYG, . M. BULL, €3. M.
DARMADYH,. HELLERJ,. P. MERRILLM, . D. MILNE, J.
OLIVER,R . PLATTF, . C. REUBI, D. RUSSELLH, . E
DEWARDENER . 11
Preliminary experiences with aspiration biopsy of the
kidney
F. RAASCHOMUD, (Third Medical Dept., Kommunehospitalet,
Copenhagen) . 15
Discussion
N. ALWALL, J. G. G. BORST,J . OLIVER,F . RAASCHOU,
F. C. REUB. I, D. RUSSELLH, . E. DE WARDENERF,. R.
WINTON 24
Renal lesions in relation to amino-aciduria and water
diuresis
E. M. DARMADYM,A , MD, MRCP . (Central Laboratory, Patho-
logical Service, Portsmouth)
27
Discussion
R. W. BERLINERE, . M. DARMADYC,. E. DENT, M. D.
MILNE, J. OLIVER, W. W. PAYNER, . PLATTJ,. R.
ROBINSON,D . RUSSELL, S. W. STANBURYH, . E.
DE WARDENER . . . 33
ix
CONTENTS
s
PAGE:
The production of hypertonic urine by the mammalian
kidney
.
H. WIRZ,M D (Physiology Institute, University of Bade) 38
Discussion
R. W. BERLINERC,. E. DENT,H . HELLERM, . D. MILNE,
J. OLIV.ER,R . F. PITTS, J. R. ROBINSON,H . E.
1 .
DE WARDENERF,. R. WINTONH, . WIRZ 43
Part I I--Tubular Functions other than thc Regulation
of Acid-base Balance
Chuirmun: PROFESSOF.R R . WINTOND, SC, MD
(Pharmacological Laboratory, University College, London)
Distribution of functional activity among the nephron
population
S. E. BRADLEYM, D,E . LEIFER,M D,a nd J. F. NICKELM, D
(Department of Medicine, Columbia University College of
Physicians and Surgeons, and Presbyterian Hospital, New
York) . 50
Discussion
R. W. BEHI.INEHS,. E. BRADLEYC, . E. DENT, A. A. G.
LEWIS,F . R.4ASCHOLJ, F. R. WINTON . 61
Some biochemical features of tubular transport mecha-
nisms
J. V. TAOGARTM,D (Department of Medicine, Columbia.
University College of Physicians and Surgeons, New York) 6.5
Discussion
R. W. BERLINERH, . HELLERJ, . P. MERRILI,,J . R.
.
ROBINSOND,. RUSSELLJ, . V. TAGGART 76
A study of the mechanism by which toxic tubular damage
changes the renal threshold for glucose
P. P. LAMBERTM, D (Laboratory of Experimental Medicine,
University of Brussels) . 79
Glucose titration renal glycosuria
in .
F. C. REUBI, MD (Medical Clinic, University of Berne) 96
Discussion
E. BALDWINR, . W. BERLINERD, . A. K. BLACKS, . E.
BRADLEYC, . E. DENT,M . G. EGGLETOPN. ,P . LAMBERT,
J. P. MERRILL,J . OLIVER,R . F. PITTS.F . RAASCHOU.
F. C. REUBI, J. R. ROBINSONP, . H. SANDERSONJ., V:
. .
‘FAOGART, H. E. DE WARDENER 107
Part III-Renal Share in the Regi~lntioito f Acid-basP
Balancc
Chairman: PROFESSOER:. BaLr>wm, PhLI
(Department of Biochemistry, University College, London)
Renal acid-base control and cell physiology
J. R. ROBINSONM, D, PhD (Department of Experimental
Medicine, University of Cambridge) . . 114
Discussion
E. BALDWINR, . W. BERLINERD. . A. K. BLACKS, .
H.
BRADLEYA,. A. G. LEWIS,R . A. MCCANCEJ,. P. MERRILL.
R. F. PITTS,J . R. ROBINSONS., W. STANBURY . . 11‘1
Regulation of the content of bicarbonate bound base in
body fluids
R. F. PITTS,M D,W . J. SCLLIVANM,D , and P. J. DORMAN,
MD (Department of Physiology, Cornell Vniversity Medical
College) . 1‘13
Discussion
E. BALDWINR,. W. BERLINERS, . E. BRADLEYM, . D.
MILNE, R. F. PITTSJ, . R. ROBINSONS,. W. STANBURY,
J. V. TAGGART. . 114
The relationship between potassium excretion and urine
acidification
R. W. BERLINERB, S, MD, T. J. KENNEDYB,S , MD, and J.
ORLOFF,M D (Laboratory of Kidney and Electrolyte Meta-
bolism, National Heart Institute, Bethesda, Maryland) .
147
Discussion
E. BALDWINR, . W. BERLINERG, . M. BULL,C . E. DENT,
R. A. MCCANCEM, . D. MILNE,W . W. PAYNER, . F. PITTS,
.
J. R. ROBINSOPN., H. SANDERSONS., W. STANBURY 1.59
Renal response to massive alkali loading in the human
subject
P. H. SANDERSO.N M,B , MRCP (Medical Unit, St. Mary’s.
Hospital, London) 165
Discussion
E. BALDWINJ,. G. G. BORSTG, . M. BULLE, . M. DARMADY,
C. E. DENT, A. A. G. LEWIS,J . OLIVERW, . W. PAYNE,
R. F. PITTS,F . RAASCHOUP,. H. SANDERSONS,. W.
STANBURYH,. E. DE WARDENER. . 173