THE INTRODUCTION OF RENAL BIOPSY INTO NEPHROLOGY FROM 1901 TO 1961 - A PARADIGM OF THE FORMING OF NEPHROLOGY BY TECHNOLOGY

'Biopsy' (Besnier 1895) became useful towards the end of the 19th cent ury with the development of good histology and microbiology. Needle bi opsy of the liver, although first performed in 1895, did not become cu rrent until 50 years later. Surgical biopsy of the kidney al incidenta l operations, particularly the then fashionable renal decapsulation, w as performed from 1900 to 1930. Percutaneous needle renal biopsy was i ntroduced after first, the successfull liver biopsy and second, demons tration of the value of aspiration needle biopsy in tumours of the kid ney. In addition, a number of physicians obtained renal tissue by acci dent and without problems during intended biopsies of the liver. Nils Alwall of Sweden performed the first systematic aspiration needle biop sies of the kidney in 1944, bur did not publish his results because of an early death which led him to abandon the technique. However, when Iversen and Brun in Copenhagen described their results in 1951, a numb er of physicians around the world immediately began to attempt renal b iopsy, using cutting as well as aspiration techniques. Success was inc onsistent and operator dependent: the refinements of technique and nee dles introduced by the group in Chicago led by Robert Kark, plus their advocacy of the technique and their training of many physicians in it s performance rapidly led to widespread acceptance. New techniques of immunofluorescence and electron microscopy arrived at the same time so that the technique could be fully exploited. The performance and inte rpretation of renal biopsies became, along with classical whole-organ and nephron physiology and the introduction of dialysis and transplant ation, powerful agents determining the emergence of Nephrology as a sp ecialty around 1960.