A History of Uremia Research

Abstract

The history of uremia research begins with the discovery of urea and the subsequent association of elevated blood urea levels with the kidney disease described by Richard Bright, a well told story that needs no recounting. What this article highlights is how clinical and laboratory studies of urea launched the analysis of body fluids, first of urine and then of blood, that would beget organic chemistry, paved the way for the study of renal function and the use of urea clearance to determine "renal efficiency," provided for the initial classification of kidney disease, and clarified the concepts of diffusion and osmosis that would lead to the development of dialysis. Importantly and in contrast to how the synthesis of urea in the laboratory heralded the death of "vitalism," the clinical use of dialysis restored the "vitality" of comatose unresponsive dying uremic patients. The quest for uremic toxins that followed has made major contributions to what has been facetiously termed "molecular vitalism." In the course of these major achievements derived from the study of urea, the meaning of "what is life" has been gradually liberated from its past attribution to supernatural forces (vital spirit, archaeus, and vital force) thereby establishing the autonomy of biological life in which the kidney is the master chemist of the living body.