Editor-in-Chief: Janusz Ostrowski IAHN Bulletin is the official E-Newsletter of the International Association for the History of Nephrology
INTRODUCTION Dear Friends, It is our pleasure to present you with the 7th issue of the IAHN Bulletin. Since the last one was out six months ago, all of us have been busy working in the hope of the improvement in the worldwide pandemic situation. As it is, though, following a short spell of relief in the summer, we are now experiencing its fourth wave crippling virtually the whole globe. Not only is this situation down to some new mutations of the virus, but also, at least in some parts of the world, insufficient numbers of vaccinations. As several countries have decided to introduce more or less stringent restrictions, a blanket lockdown included, the operation of our Association has had to slow down, resulting in a smaller number of papers submitted for publication. Considering the difficult situation, an online meeting of the IAHN Council was held in September earlier this year to discuss the next Congress provisionally scheduled for June or September 2022 in Istanbul, Turkey. Nevertheless, with Christmas and the New Year coming up, we all remain hopeful for a much better future. I take this opportunity to wish all our members, supporters and readers a lot of health, peace and a rapid return to the pre- pandemic normality. May we see again in person soon! Janusz Ostrowski
No. 7, December 2021
Janusz Ostrowski Professor, Centre of Postgraduate Medical Education, Warsaw, Poland janusz.ostrowski@cmkp.edu.pl
Board of the International Association for the History of Nephrology Iwannis Stefanidis – President Janusz Ostrowski – Past President Ayse Balat – President Elect Vincenzo Savica – Treasurer Natale G. De Santo - (ex officio) Councillors:
Maria Kalientzidou Biagio Ricciardi Davide Viggiano Achmet Aciduman   Sylvie Opatrna        Przemysław Rutkowski
Professorial Roles In 1969 he became Assistant and later, Associate Professor of Nephrology at the University of California, San Francisco. In 1972 he moved to the University of Colorado, Denver as Head of the Division of Renal Diseases and Hypertension. This was the start of a development programme which, over the next 30 years, achieved enormous success. He promoted training of Fellows in renal medicine and research. He was especially involved in the mentorship of Fellows-ultimately over 200 passed through his department. His research work extended beyond nephrology into cardiology, liver disease and pregnancy. A Spanish hepatologist described Schrier as “one of the greatest nephrologists of all time” (2) noting Bob’s findings that in cirrhosis, fluid retention related to under-filling of the arterial circulation secondary to increases in vasodilators, especially nitric oxide. This led to the now standard treatment for the Hepato-Renal Syndrome (3). In 1976 he became Chair of Medicine, a post he held for 26 years-the longest-serving chairman of a Division of Medicine in the USA. He built up the faculty membership from 75 to over 500, and increased annual research funding from $3 million to nearly $100. He attracted uninterrupted, competitive funding from the National Institutes of Health for 45 years and generated endowments for 30 chairs in various branches of Medicine. His sectional heads were highly qualified specialists in areas including respirology, cardiology, oncology, haematology and internal medicine. Beyond these achievements he maintained a very active research profile, took part regularly in clinical Nephrology, and was always a dedicated family man. He developed training programmes for medical students, junior doctors and researchers. His home was regularly the site for mentoring these people at weekends. In his lifetime Bob published over 1000 scientific papers and edited, authored or co-authored over 50 books. Of note were some of the most-referred-to books on Nephrology, especially his giant reference book “Diseases of the Kidney and Urinary Tract”, recognised as the most comprehensive textbook of its kind ever published. Medical Societies/ The International Society of Nephrology. Given his medical and scientific status, not surprisingly, Bob was a member of many societies. At varying times, he was President of the Association of American Physicians, the American Society of Nephrology, the National Kidney Foundation and the International Society of Nephrology (ISN, 1995-97). He was elected to the National Academy of Medicine in 1989, made an Honorary Fellow of the Royal College of Physicians UK in 1998, and Honorary Member or Professor of the societies of nephrology of South Africa, Paris, Germany, Beijing, Africa, Poland, Thailand, Columbia and Slovakia. During his long period with the ISN he promoted global development of nephrology. He launched the ISN Fellowship Program whereby physicians in under-developed countries were sponsored to train in nephrology for 2 years at established renal centres; over 600 doctors passed through this programme, most returning to their own countries to care for renal patients and teach others. He developed the Sister Renal Centers Program which links developing kidney units with established units. By 2014 there were over 50 pairings worldwide; the most productive receive the Robert W Schrier Award at ISN World Congresses. Post-Retirement “Retirement” is an inappropriate term in relation to Bob Schrier. After 2002 Bob’s main academic activity related to Autosomal Polycystic Kidney Disease (APKD). He continued to research mechanisms of salt and water retention in heart failure, liver disease, kidney disease and pregnancy. His long- term interest in fluid balance, oedema, hyponatraemia continued, along with other renal disorders. Diabetes mellitus-another major cause of kidney failure-also featured strongly in his research. He continued active mentorship and, aged 75 years, this was recognised with a major award for Academic Mentorship. Between 2003 and 2018 he had 177 publications; 63 related to APKD, fluid balance (44), fluid retention in heart failure, cirrhosis and pregnancy (18) and diabetes (16). Outside of medicine he pursued an interest in American history, writing and lecturing on the political and medical events in the lives of 20th century US Presidents (4), and, separately, about the lives of famous world leaders- Lincoln, Gandhi, Mandela and Luther King (5). A later book was his Memoirs, entitled “Life’s Lessons Learned” (1). In 2012 at the age of 76 he became Professor Emeritus, University of Colorado School of Medicine. Some Quotes Bob - one of his favourite quotes was from George Bernard Shaw:” Some men see things as they are and ask ‘Why?’. Others dream of things that never were and ask ‘Why not?’. Thomas Berl—Bob’s successor at Colorado: “His most enduring legacy may be his commitment to mentor the large number of fellows and scientists who spent from weeks to years in his research programme” (6). Bob, on his wife Barbara— “Her legacy, as leader of our family, dwarfs anything that I have ever done” (1). Barbara on Bob—after his passing: “Bob sought the best in others and gave the best he had” (6). Bob Schrier: sportsman, doctor, researcher, leader, husband, father. A giant, physically, medically and academically. Dr Malcolm Phillips References 1. Life’s Lessons Learned: My Memoirs, Schrier R W. 2014. Pub: Create Space Independent Publishing Platform USA. 2. Robert W Schrier: an influential observer from outside Hepatology (Obit). Gines P. 2021. J Hepatol 74,1281-1282 3. Renal Failure in Cirrhosis Gines P, Schrier R W. 2008. New Engl J Med Sep 24, 361 (13), 1279-1290. 4. Profiles of American Presidents in the Twentieth Century: Merits and Maladies, Schrier R W. 2011. Pub: Create Space Independent Publishing Platform USA. 5. Moral Courage: Abraham Lincoln, Mahatma Ghandi, Nelson Mandela, Martin Luther King Jr, Schrier R W 2012. Pub: Create Space Independent Publishing Platform USA. 6. In Memoriam: Robert W Schrier 1936-2021, Berl T, Linas S. 2021. Kid Intl 99, 1042-1044
Robert William Schrier (1936-2021). Renowned and respected nephrologist. Missed by us all. Robert Schrier-Bob- was born in Indianapolis in 1936. His mother was a nurse, his father, a printer who died when Bob was 3 years old. He had a glittering career in Medicine becoming a world leader in Nephrology. He was universally liked and respected. He died in January 2021, leaving a wife, 4 children, 13 grandchildren and 2 great- grandchildren Early Days His college education started in Indianapolis at De Pauw University where, in 1957, he received his Bachelor’s Degree. There he met Barbara, his wife-to-be, who he married in 1959. The marriage lasted almost 62 years. In 1957, he won a Fulbright Scholarship which took him to Johannes Gutenberg University, Mainz, Germany. From school age he was recognised as a talented basketball and baseball player. Such was his involvement in these sports that he admits, in his Memoirs (1), he managed to fit in a game of baseball on his wedding day. He recited his vows on time- but it was a very close call! He considered a career in basketball but, happily for the world of Medicine, chose to go to Indiana University Medical School. He graduated MD in 1962. His first medical position was at Marion County General Hospital, followed by 2 years residency at the University of Washington, School of Medicine, Seattle. This was followed, in 1965, by a Fellowship at Harvard at the Peter Bent Brigham Hospital where his research was in Endocrinology and Metabolism. This was the start of what became his lifelong interest-the renal regulation of salt and water. In 1966 he entered the army, working at the Walter Reed Hospital and the Army Institute of Research. That year he met Hugh de Wardener, Professor of Medicine, Charing Cross Hospital, London, who invited him to work with him on the renal mechanisms of sodium transport. Bob travelled to London in 1967. After 10 months he returned to USA to complete military service.
Dr Malcolm Phillips Nephrologist and Medical Director Charing Cross Hospital, London (retired)
Andrzej Oko President of the Polish Society of Nephrology
Figure 1. Professor Alicja Grzegorzewska (Photo. Janusz Ostrowski)
The kidney may cause hyperuricemia, but is also the target of hyperuricemia (calculi, renal disease, and its progression). At onset, gout affects one joint, frequently the metatarsophalangeal joint of the great toe, that is self-limited and heals within two weeks. Flare-ups subsequently affect two or more joints, becoming a chronic disease when tophi and erosions of the joint appear. Risk factors are disease with high cell turnover and high intake of purine rich foods (meat, crustaceans, alcohol, syrup containing fructose). It increases with age and women become hyperuricemic after menopause. It affects patients with hypertension, diabetes mellitus, chronic kidney disease. The diagnosis is made by demonstrating sodium monourate crystals in a joint by polarization microscopy or fine needle aspiration of tophi. The prevalence is 1% in Italy and in France, 2.5% in United Kingdom, Spain, Netherland, 3.9% in the USA and 1% in China. It is rare in Portugal, Czech Republic, former Soviet Union, Turkey, Malaysia, Japan, Korea, African countries. The prevalence increases in senior citizens of 70-80 years of age. Gout is the oldest recorded inflammatory arthritis to affect humankind, with roots stretching back to 2640 BC. It has been known as “the unwalkable disease”(Hippocrates), for which protection was granted by the Goddess Artemis Podagra. Its heritability was recognized by Galen (AD 129-c216) and by by Aretheus (AD c150-200) in On the Causes of acute and chronic diseases. Soranus of Ephesus (floruit 98-138 AD) described tophi that were widely discussed by the Byzantine physician Alexander of Tralles AD 525-605) who illustrated the virtues of Cholchicum autumnale (meadow saffron). Many other Greek and Byzantine authors (2) have written on podagral, derived from the Greek stems poûs (foot) and agra (seizure. Oribasius (c.320-400 CE) wrote that gout affects the feet, whereas arthritis affects other joints and suggested to use a mixture of germander and white centaury known as Remedy of Proclu. Aētius Amidenus (6th Century AD) in De Morbis acutis et chronicis) pointed out the similarity of podagral with arthritis and sciatica due to a humour entering in the nerve and then reaching the joints (9. Demetrius Pepagomenus wrote on the chronicity of gout a disease caused by a functional deficit of bile and phlegm (whereas Johannes Actuarius (1275-1328) supported the concept that the effect of the bad humor had its origin in age and a lifestyles. It has been known as “the rich man’s disease”, “the patrician malady“ “a disease of plenty”, “disease of the lords and lord of disease”, “disease of affluence”, “disease conferring a badge of nobility”, “the disease increasing the social status of those affected”, “disease of Western Society ”, and also , “a life-style disease”, and “a patrician malady no more”. Its name derives from the Latin word gutta (drop) to indicate the drop of a humour in excess precipitating in the joint. Gutta was originally coined by Randolphus Bocking (1197/1258) who pointed to the excess of one humour. Garrod made seminal experiments on the role of uric acid (1848). Having found a cure for the disease—allopurinol, still the most used Gertrud B. Elion (1918- 1999) and George H. Hitchings ( 1905-1998) received the Nobel Prize for Medicine in 1988. We have studied gouty stone disease in popes, who being persons of affluence and distinction, have traditionally had a mean life span exceeding those of their contemporaries. Scarce data on gouty popes are available. This is surprising since popes by definition are persons of affluence and distinction and have a life expectancy that by far exceeds those of their contemporaries. In fact, from the 17th to the 21st centuries, it has been in the range of 75 to 79.3 years (3), and, as mentioned before, hyperuricemia increases up to 70- 80 years. Furthermore, the lives of popes from the year 1000 onwards have been scrutinized thoroughly since the Popes have been active protagonists of history in Europe and beyond, so their lives not only attracted the attention of their physicians, but also historians since the number of references is enormous. In December 1934 Lorenzo Gualino (4) dedicated to “gouty syndrome a very extensive and documented section of “Storia Medica dei Romani Pontefici / Medical history of Roman Pontiffs” identifying 19 gouty popes ruling the Catholic Church in the years 590 to 1758, whereas a 2003 monograph by Ceccarelli described 11 gouty popes in the years 1492-1903 (5), Furthermore, in a 2006 paper on deaths of popes, Retieff and Ciliers identified a group of eight gouty popes reigning in the years 590-1830 (3). Finally, Giorgio Cosmacini in a book on the link between medicine and papacy (6) published in 2017, identified 8 gouty pontiffs reigning in the years 999 to 2013. The above studies, apart from that by Gualino, lack systematic investigations on the prevalence of gout in popes, do not take into consideration the environmental conditions, dietary habits, or attitudes towards physical activity. They lack precise descriptions of the disease presentation at the first attack and of the subsequent flare-ups, do not address the intercritical periods between flares, nor inform about association with nephrolithiasis, renal pain, and urinary sepsis. The chronic effects of gout on the quality of life of the popes, the remedies they received by the archiaters and personal physicians and the causes of death were not globally addressed. Finally, the available list of gouty popes is incomplete, and suggests that there might be gouty popes not yet identified. Therefore, we have embarked in a series of studies aiming to define the natural history of gout in popes with special interest for their renal stone disease and the causes of death. Preliminary data were presented at various congresses (7-11) and finally a review was recently published (12). Data were obtained on the largest series of gouty popes (no. 25) ever studied, along with the disease presentation, its time-course and the causes of death (12). Methods We have studied the clinical narratives of all gouty popes identified by Gualino, Ceccarelli, Retief and Ciliers and by Cosmacini (3-6)) and additionally searched for all gouty popes from St. Peter (34 AD) to Bergoglio (2014). We have scrutinized the histories of popes of Bartolomeo Sacchi―known as Platina―(1421-1481), Luigi Gaetano Marini (1782-1815), Giuseppe de Novaes ( 1736-1821) Leopold von Ranke (1795-1896), Mathieu-Richard Auguste Henrion (1805- 1862), the recent monographs of Claudio Rendina, Peter G. Maxwell-Stewart, and Wendy J. Reardon ) and some online encyclopedias. Gout was diagnosed through the clinical narrative pointing to an acute painful condition of the big toe (podagra) , its onset at night, its recurrence over the years. Importance was given to the association with fever, flank pain, sands, stones, tophi, difficulties in standing and walking the need of special chairs the impossibility to cope with papal duties and absence at special celebrations of liturgical year. Chiragra was identified by acute and recurrent painful attacks of inflammation of the joints of the hands presenting with swelling, tenderness, redness, and limited function (functio laesa). Notes were taken about chronic deformation of the hands and the difficulties in bringing drinks and foods to mouth, riding , and celebrating mass. The study was completed by analysis of data on obesity, quality and quality of foods and drinks, the visits to spas for baths and special waters, and the suggestions of archiaters and special consultations with great physicians. Results We report herewith 4 case histories that can be found in the depository of data related to the recent review (12). Boniface VIII (1294-1303). He was born Benedetto Caetani at Anagni c.1230. He was elected Pope after the withdrawl of Celestine V, and is considered one of the greatest popes although Dante Alighieri charged him with simony and nepotism. “He was chronically affected by gout and renal stone disease - podagra, chiragra - and by the fear for death, and the search for therapies to prolong life. Cosmacini says ”podagroso e gottoso… the Pope is affected by arthritis and renal disease due to overeating rich foods (straricca in Italian) such as meat“. Boniface enrolled fourteen archiaters, among them Taddeo Alderotti (1223-1295), Pietro da Abano (1257-1315), Anselmo da Bergamo (artis physicae professor), Simone of Genova (author of Clavis sanationis), Accursino from Pistoia, Manzia from Fabriano, Gugliemo da Brescia, Angelo da Camerino and Campano da Novara (Magister Campanus), the naturalist he too affected by renal stone disease. Boniface was the founder of the Holy Year in 1300 and of the University La Sapienza in Rome (Bulla of April 29, 1303).He authored the Bulla detestandi feritatis/dissection (September 27, 1299). For this Bulla during the subsequent centuries he was wrongly accused even by Herman Boerhaave and Albrecht von Haller of slowing the advancement of medicine by impeding progress in anatomy. Sixtus IV (1471-1484). Born Francesco della Rovere in 1414, he is remembered for the splendor of the Sistine Chapel (he hired Verrocchio, Botticelli, Pinturicchio, Perugino, Ghirlandaio, Melozzo). He also promoted the foundation of the Hospital Santo Spirito, and the development of the Vatican Library. He nominated as its director Bartolomeo Sacchi, known as Platina, as shown by a painting of Melozzo in the Vatican Museum. SIXTUS IV is very important for the short apostolic letter (littera in forma brevis) to the President of the University of Tubingen who had inquired about the possibility of utilizing the bodies of executed people to learn anatomy. “We give you the permission to utilize the corpses of executed persons to dissect them”(April 4, 1582). CLEMENT VIII (1592-1605). Born Ippolito Aldobrandini, he was the pope who convicted Giordano Bruno. He suffered frequent attacks of gout of the foot, especially the great toe. He had arthritis and nephritis. His pallor makes a diagnosis of chronic kidney disease probable. His physician prescribed drinking a lot of liquids. In the last months he had various attacks of “podagra, flank pain, with insomnia and lack of appetite”. In January 1605 he had stroke, loss of word, delirium, somnolence, compulsive drinking, amnesia. He died of cerebral hemorrhage (mal di goccia, cerebral extravasation Lifestyles of gouty popes Gregory I Magnus chose modesty in every aspect of life, even his horses and his mounts were modest. Some were frugal, such as Pius II, Pius III, Gregory XV, Innocent XI, Benedict XIV, Benedict XV and Gregory I Magnus who ate cabbages and died malnourished. Benedict XIV was a sober eater and dined with cinnamon flavored water. Some popes gave special importance to food: Julius III invested in foods and wines no less than 8,000 ducats per month. Boniface VIII, Julius I and Julius III were voracious eaters. Pius IV used to eat five time a day. Gregory I, Magnus, Pius II, Honorius IV and Pius III, despite their attitudes toward foods, used to fast in sign of penitence. Pius IV and Julius II enjoyed drinking wine. Pius II mixed it with water. Nicholas V, a sober drinker, had on his table “two small jugs with a wide body and a narrow neck -one for red wine and the other for white wine”. But he really used them to offer wine to his important visitors from France, Germany and Hungary who might appreciate the value of the wine. Pope Benedict XIV drank a small amount of wine from Montepulciano at lunch and preferred to drink water with cinnamon for the rest of the day. Julius II loved exercise “motion maintains health and drives out disease, I don’t want to die bedridden”. Boniface VIII, Clement VI, Callixtus III, Nicholas V, Pius II, Sixtus IV, Pius III, Julius II, Marcellus II, Clement VIII, Gregory XV, Pius IV, Clement X, Innocent X, Innocent XI, Clement XII had narratives of podagra, chiragra, sands, renal stone disease, flank pain, disury, with or without fever, small Kidneys and/or stones at autopsy. Benedict XIV, needed bladder catheterization every two and half hours, a procedure that was performed by his physician Peter Pozio. Renal disease in gouty popes As reported elsewhere (12) 25 of 264 popes (Table 1, Figures 1-5) were found gouty (9.47%); 68% had renal disease; 70.6% underwent a renal death; 58% had risk factors, 25% had comorbidities), 84% had inability to perform duties. Renal disease did not affect age at death and inability to perform duties. Now gout is no longer a papal disease. A total of 7 out 25 popes (28%) died of stroke or after one or more bouts of transient ischemic attack: Marcellus II at 54, Sergius II at 57, Sixtus IV and Clement VIII at 70, Honorius IV at 77, Innocent XII at 85, Clement XII at 88: Various TIA before death. Hyperuricemia as a risk factor for stroke has long been debated. Recently hyperuricemia was shown to be a significant risk of stroke (and that the risk is equal to that of diabetes mellitus. This is not surprising since chronic kidney disease may cause hyperuricemia, and in addition, gout is associated with a high incidence of CKD, with disease progression to end-stage kidney disease (12). Gout and the Theory of Epidemiological Transition Thus, gout had a high prevalence in popes and was practically absent in the population. This may be well explained by means of the Theory of Epidemiological Transition. The theory was advanced in a landmark paper of Abdel R. Omran “after the conquest of infectious disease” and the emergence of degenerative and “man-made diseases”, after World War II (13). Using demographical tools, Omran analyzed the changing patterns of population age distribution in relation to changes in mortality, fertility, life expectancy, causes of death. The theory has been updated frequently, and finally poverty has been taken into consideration along with incomes and education. It is evident that the rich well educated class adopted intemperant lifestyles as did poorly educated classes; however, the rich educated class when made aware of risks have adopted healthy lifestyles, a goal presently missed by the poor and less educated populations at greater risk (14). Acknowledgements Joseph Sepe MD, Professor of Biological Sciences, University of Maryland Global Campus, USA, Adjunct Professor—Department of Mathematics and Physics University of Campania, Luigi Vanvitelli, Naples, Italy for English revision. References 1. Dalbeth N, Choi HK, Joosten LAB, Khanna PP, Matsuo H,, Fernando Perez- Ruiz F and Stamp LK (2019). Gout. Nature Reviews Disease Primers 5:69 doi.org/10.1038/s41572-019-0115-y 2. Savica V, Santoro D, Ricciardi B, Ricciardi CA, Calo LA, Bellinghieri G. Morbus dominorum: gout as the disease of lords. J Nephrol. 2013 Dec 23;26(Suppl. 22):113-116. doi: 10.5301/jn.5000349. Online ahead of print.PMID: 24375354 3. Retief FP, Cilliers L (20005). Disease and causes of death among popes. Acta Theologica S233-S246 4. Gualino L. Storia medica dei Romani pontefici. Minerva Medica, Torino1934 5. Ceccarelli G (2001). La salute dei pontefici. Da Alessandro VI a Leone XIII (1492- 1503). Ancora, Milano 6. Cosmacini G (2018). La medicina dei papi. Laterza, Roma 7. De Santo NG, Bisaccia C, De Santo LS (2019). Causes of death due to disease of the genito-urinary system and of the heart among 264 popes in the years 65-2005 AD: First approach .Nephrology Dialysis Transplantation, Volume 34, Issue Supplement_1, gfz103.SP804, https://doi.org/10.1093/ndt/gfz103.SP804. Published:13 June 2019 8. De Santo NG, Bisaccia C, De Santo LS (2019). Deaths caused by cardiorenal disease among 264 popes from St. Peter to St. John Paul II. Hellenic Nephrology 31: 158. 9.De Santo NG, Bisaccia C, De Santo LS (2020). Papal deaths caused by cardiorenal disease. First Approach. Arch Hell Med 37(S2): 177-181 10. Bisacccia C, De Santo LS, De Santo NG (2020). Gout a papal disease: a study in 20 pontiffs (540-1830. Nephrology Dialysis Transplantation, Volume 35, Issue Supplement_3, gfaa144.P1836, https://doi.org/10.1093/ndt/gfaa144.P1836 11. De Santo N, Bisaccia C, De Santo (2021). Renal stone disease in 193 pontiffs from Vigilius to Pius VIII. (537-1830). Nephrology Dialysis Transplantation . DOI: 10.1093/ndt/gfab105.001 12. De Santo NG, Bisaccia C, De Santo LS. Gout: a papal disease-a historical review of 25 gouty popes (34-2005 AD). J Nephrol. 2021 Oct;34(5):1565- 1567. doi: 10.1007/s40620-021-01117-8. Epub 2021 Jul 28. PMID: 34319565. 13. Omran A R. The epidemiologic transition. A theory of the Epidemiology of Population Change, Milbank Memorial Fund Quarterly 1971; 49(4). 509- 538 14. Pearson TA. Education and income: double edged swords in the epidemiologic transition of cardiovascular disease. Ethnicity & Disease 2003; 13: S2- 158-S2-163 Table 1 – Gouty pontiffs.
Figure 1 – Popes reigning in the years 590-604.
Figure 2 – Popes reigning in the years 1294-1303.
Figure 3 – Popes reigning in the years 1471 – 1484.
Figure 4 – Popes reigning in the years 1559-1676.
Figure 5 – Popes reigning in the years 1676-1830.
The all-online 10th Top Nephrological Trends Congress was held on October 8-9, 2021 in Poznań, Poland. Ever since its beginning, the congress has been organised by Professor Andrzej Oko, the Head of the Department of Nephrology, Transplantology and Internal Medicine at the Medical University of Poznań, and the current President of the Polish Society of Nephrology. The rich programme included members of the IAHN from Poland. Professor Bolesław Rutkowski was the chairman of one of the scientific sessions, while prof. Przemysław Rutkowski gave a lecture entitled “Epigenetics in the service of medicine”. Moreover, the author of this information gave a lecture on an outstanding Polish internist at the turn of the 19th and 20th centuries, prof. Anastazy Landau. The lecture was titled “Professor Anastazy Landau (1876-1957) and his contribution to the development of nephrology”. Top Nephrological Trends is one of the Polish highest rated conferences in nephrology. Janusz Ostrowski
On October 11, 2021, the inauguration of the academic year took place in a hybrid formula at the Medical University of Gdańsk. The ceremony was honoured by the presence of the Minister of Health of Poland, Adam Niedzielski. During the celebration the title of Aesculapius Gedanensis was awarded to prof. Bolesław Rutkowski. The dignity an Honorary Professor of the Medical University of Gdańsk, has been awarded since 2018 in recognition of outstanding scientific achievements or merits for the development of the University. Having received the title, Professor Bolesław Rutkowski gave a lecture entitled “Chronic Kidney Disease: a Pandemic of the 21st Century” and the next issue of Gazeta GUMed (Gdańsk Medical University Newspaper) featured a wide coverage of the ceremony. Professor Bolesław Rutkowski is a long- term Head of the Department of Nephrology, Tansplantology and Internal Medicine of the Medical University of Gdańsk, a former President of the Polish Society of Nephrology, a long-standing former national consultant in the field of nephrology, who has enjoyed many titles and awards and has served many important roles in the world of medicine: the Distinguished Medal of the National Kidney Foundation (NKF), Distinguished Fellowship of ERA- EDTA, Former President and Honorary Member of the IAHN to name just a few. Professor Bolesław Rutkowski is recognised by the community of nephrology as one of the greatest scientific authorities in Poland. Janusz Ostrowski
Figure 2. Professor Bolesław Rutkowski (photo. Janusz Ostrowski)
It was back in 2000 when the first Katowice Seminars “Advances in nephrology and hypertension” was held. The 21st edition of this extremely popular and presenting a superb scientific level event took place earlier this autumn. To date, every year, the most renowned representatives of the world of nephrology have shown up in Katowice and it was no different this time. The participants had a pleasure to hear Prof. Natale De Santo who not only gave a fascinating lecture, but also received the honorary membership of the Polish Society of Nephrology. From the very beginning, the seminars have been organised by Professor Andrzej Więcek, the Head of the Department of Nephrology, Transplatation and Internal Medicine, Medical University of Silesia. Professor Andrzej Więcek is the former President of the Polish Society of Nephrology and the ERA-EDTA, and an honorary member of the IAHN. Due to the pandemic restrictions, this year’s seminar was held on November 25-27 in a hybrid form. The first session was marked by an active participation of IAHN members. Prof. Przemysław Rutkowski gave a lecture on “Green Nephrology - the needs and possibilities of environmental protection in nephrology”, prof. Bolesław Rutkowski presented the lecture “Gender and chronic kidney disease”, and prof. Janusz Ostrowski discussed “The discoveries in the morphology and physiology of the kidneys. Views on tubulo-glomerular feedback”. The former President of the European Renal Association, prof. Raymond Vanholder also participated in the seminar that was again highly evaluated by all the participants. It is generally hoped that the next one will be live. Janusz Ostrowski
21 KATOWICE SEMINAR “Progress in nephrology and hypertension”
Figure 1. Professor Przemysław Rutkowski
Figure 2. Professor Bolesław Rutkowski
Figure 3. Professor Janusz Ostrowski
Figure 2. Professor Alicja Grzegorzewska (Photo. Janusz Ostrowski)
Natale G. De Santo, MD Emeritus Professor, University of Campania Luigi Vanvitelli, Naples, Italy
Figure 1. Professor Robert Wiliam Schrier
Professor Alicja Grzegorzewska (1949-2021) Alicja Grzegorzewska was born on 18th November 1949. She graduated from medical studies in the Doctors’ Department of the Medical Academy in Poznań, Poland in 1973. Three years later, she obtained her I-degree specialisation in internal medicine, followed by the II-degree in nephrology in 1979. Only 2 years later, in 1981, she obtained her PhD title in medicine following a dissertation: Research on uric acid excretion during peritoneal dialysis in patients with chronic kidney disease. In 1989, she received the title of a habilitated doctor in medical sciences on basis of her work: The comparison of some pharmacological and conventional methods to increase the efficiency of peritoneal dialysis sessions. She became professor in 1997. Earlier, in 1990, she spent a year working at Dalton Research Center at the University of Missouri, Columbia, USA. In 1996-1997, she held the position of the Head of the Faculty and Clinic of Nephrology at the Medical Academy in Poznań, Poland. A. Grzegorzewska was a supervisor of 14 doctoral programmes, including 6 completed with honours, and 15 master programmes. Additionally, she supervised 5 completed specialisation programmes in nephrology. Her list of scientific achievements was rather impressive and her expertise in peritoneal dialysis was hard to match. The short list of international and Polish journals in which she published includes Kidney International, Nephrology Dialysis & Transplantation, Journal of Artificial Organs, Peritoneal Dialysis Bulletin, Peritoneal Dialysis International, Nefrologia i Dializoterapia Polska (Polish Nephrology and Dialysis Treatment), Polskie Archiwum Medycyny Wewnętrznej (Polish Archives of Internal Medicine), Przegląd Lekarski (Doctor’s Review). Her total Impact Factor stood at 105.
Prof. Alicja Grzegorzewska was the Chairperson of the Organising Committee of the 5th Congress of the Polish Society of Nephrology and the President of its Poznań Branch for two terms. In the years 2002-2007 she was a Medical Consultant in the field of Nephrology for the Greater Poland Voivodeship. She was a member of the Polish Society of Nephrology and the ERA-EDTA. For her remarkable achievements, she has received many awards and distinctions: individual awards of the Minister of Health in Poland, scientific and didactic awards of the Rector of the Medical University in Poznań. In 2013 she became an ERA-EDTA Distinguished Fellow (FERA). Professor Alicja Grzegorzewska died on November 16, 2021. Andrzej Oko Janusz Ostrowski
Natale Gaspare De Santo1, Carmela Bisaccia2, Luca S. De Santo3 1University of Campania Luigi Vanvitelli, Naples, 2Mazzini Institute, Naples, 3Division of Heart Surgery, Department of translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples. All in Italy. Introduction Gout is a common, complex, systemic and well-studied form of chronic inflammatory arthritis in adults (1) for which many options are now available. It is due to deposition of sodium monourate crystals in peripheral joints and periarticular tissues driven by hyperuricemia at or above 6.8 mg/dl. Hyperuricemia is caused by genetic, environmental factors as well as by urate transporter dysfunction in the gut and in the kidneys. Hyperuricemias are due to either renal overload, renal underextretion or a combination of both Renal overload may be due to overproduction by dietary purines, endogenous purine synthesis, purine breakdown and purine salvage (Hypoxanthine-guanine phosphoribosyltransferase deficiency and 5-Phosphoribosyl-1-pyrophosphatedeficiency). Cristal deposition—activates a) the NOD-like receptor protein 3 (NLRP3) inflammasome causing—via caspase- 1—release of the cytokine IL-1β and b) activates proteinase 3 and elastase. The kidney may cause hyperuricemia, but is also the target of hyperuricemia (calculi, renal disease, and its progression). At onset, gout affects one joint, frequently the metatarsophalangeal joint of the great toe, that is self- limited and heals within two weeks. Flare-ups subsequently affect two or more joints, becoming a chronic disease when tophi and erosions of the joint appear. Risk factors are disease with high cell turnover and high intake of purine rich foods (meat, crustaceans, alcohol, syrup containing fructose). It increases with age and women become hyperuricemic after menopause. It affects patients with hypertension, diabetes mellitus, chronic kidney disease. The diagnosis is made by demonstrating sodium monourate crystals in a joint by polarization microscopy or fine needle aspiration of tophi. The prevalence is 1% in Italy and in France, 2.5% in United Kingdom, Spain, Netherland, 3.9% in the USA and 1% in China. It is rare in Portugal, Czech Republic, former Soviet Union, Turkey, Malaysia, Japan, Korea, African countries. The prevalence increases in senior citizens of 70-80 years of age.
Figure 1. Professor Bolesław Rutkowski (photo. Janusz Ostrowski)
PROFESSOR MOMIR POLENAKOVIC (1939-2021) Professor Momir Polenakovic MD was born on April 26th, 1939 in Skopje in the intellectual family, where the atmosphere of research was present almost each day. His father was a Professor at the University of Sts. Cyril and Methodius in Skopje, and also one of the founders of the Macedonian Academy of Sciences and Arts and its first Vice President. Momir Polenakovic’s mother was one of the founders of the first Ethnographical Museum in Skopje and in Macedonia after the Second World War (1). Professor Momir Polenakovic died in Skopje on March 6th, 2021. Professor Polenakovic graduated at the Medical Faculty of the Sts. Cyril and Methodius University in Skopje and received his M.D. degree in 1963. He was the best student of the generation at the Medical Faculty of the Sts. Cyril and Methodius University in Skopje. Already during this time he was very active and in the period of 1958-63 he was a member and subsequently a Head of the International Cooperation Department of the Student Association of the Medical Faculty in Skopje (2). After completion of his medical learning, he continued his education at the Clinic of Internal Medicine and Nephrology in Skopje and at the Military Medical Academy in Belgrade, Serbia. Professor Polenakovic was also appointed for one year as a fellow at Northwestern University in Chicago (USA). During this time he was invited to give lectures at the University of California, Los Angeles (UCLA), the University of San Diego – Scripps Clinic, at the Harvard Medical School, Boston and in the National Institute of Health (NIH). In 1969 he became Assistant and later, Associate Professor of Nephrology at the University of California, San Francisco. In 1972 he moved to the University of Colorado, Denver as Head of the Division of Renal Diseases and Hypertension. This was the start of a development programme which, over the next 30 years, achieved enormous success. He promoted training of Fellows in renal medicine and research. He was especially involved in the mentorship of Fellows-ultimately over 200 passed through his department. In 1977 he defended his Ph.D. thesis based on the study entitled: “Clinical and immunological evaluation of pathological events in renal glomeruli”, becoming an assistant Professor. In 1983 he became an associate Professor and in 1988 a full Professor of internal medicine at the Medical Faculty, University “Sts. Cyril and Methodius”, Skopje (3). He was also elected as a Vice Dean of the Medical Faculty, University Sts. Cyril and Methodius, Skopje from 1982-1984. From 1990 to 1997 Professor Polenakovic was a head of the Department of Nephrology, University “Sts. Cyril and Methodius” in Skopje. At that time, Department of Nephrology in Skopje became one of the first “centres of excellence in Eastern Europe where many young nephrologists received their clinical training and the first dialysis in Macedonia in patients with acute (1965) and chronic (1971) renal failure was performed. Additionally the first percutaneous kidney biopsy in Macedonia was made in 1970 and first successful kidney transplantation was performed in his Department in 1977. Professor Polenakovic was the first who in 1962 wrote about the Balkan Endemic Nephropathy epidemic in the English language and suggested originally, that environmental factors may cause renal diseases (1). In 1997 he was elected as a member of the Macedonian Academy of Sciences and Arts where he served as a Vice President from 2004 to 2007. In 2015 Professor Polenakovic retired but still remained very active and from 2011 until 2017 he was appointed as a Head of the Research Centre for Genetic Engineering and Biotechnology “Georgi Efremov” of the Macedonian Academy of Sciences and Arts (3). Professor Polenakovic published more than 250 articles registered in the Medline, mainly focused on glomerulonephropathies, tubulointerstitial diseases (especially Balkan Endemic Nephropathy), diabetic nephropathy, polycystic kidney disease, chronic renal failure, dialysis and plasmapheresis.
Professor Andrzej Więcek Head of the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
Professor Momir Polenakovic was very active and instrumental in creation of nephrological societies and organizations within the Balkan countries, especially within the former Yugoslavia. In 1970 Professor Momir Polenakovic together with Prof. Hrisoho founded the Macedonian Nephrology Society of the Macedonian Medical Association. Few years later, Professor Polenakovic was involved in the creation of the Yugoslav Nephrology Association established in 1975 in Nis, Serbia (2). In 1992 Professor Polenakovic created the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) and was President of this Society in the period 1992–2011, and later on a lifetime honorary President. In 1993, the First Congress of the MSNDTAO was organized in Ohrid under the Presidency of Professor Polenakovic. During this Congress for the first time the idea to launch the Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was announced. Professor Polenakovic was not one of the founders but later on he became a President of BANTAO from 1997 until 1999 (2). His national and international activity was appreciated and he was elected a President of the Macedonian Medical Association for the period from 1984 until 1986, later on as a President of the Macedonian Society for Basic, Clinical Immunology and Allergology in the period 1992–1996. Additionally, during the period 1985–1989 he was elected a President of the Yugoslav Society of Nephrology (2). These activities were also acknowledged by European nephrology community and Professor Polenakovic was elected as a Council Member of the ERA-EDTA for the period 1989–1991. Together with the Yugoslav Society of Nephrology he was involved in the preparation of the XXVIII ERA-EDTA Congress, September 1-4, 1991 in Belgrade, as a Secretary General (Prof. V. Petronjic was the Congress President at this time). Unfortunately, due to the Balkan war, Yugoslavia was divided into several countries and the Congress was moved to Rimini in Italy, November 6-9, 1991 (2). From 1997 to 2005 Professor Polenakovic served as a member of the Board of Governors of the European Society for Artificial Organs (ESAO) and in 2010 he organized in Skopje very successful XXXVII Congress of ESAO (2). In 2013 Professor Polenakovic received several international recognitions, namely he became a Distinguished Fellow of the European Renal Association (ERA-EDTA) and additionally he received the ISN Pioneer Award for the region of Central and Eastern Europe. On September 26th –27th, 2014, International Nephrology Days were organized in honour of the 75th anniversary of Professor Momir Polenakovic and 50 years of his scientific work. During this Conference he received a certificate from the ERA-EDTA “for his important role in the development of nephrology in the Balkan region and his constant support for ERA-EDTA, especially at the occasion of the 1991 ERA-EDTA Congress when he gave his full support to the ERA-EDTA even in extremely difficult circumstances”. It is also important to mention that Professor Polnekovic was an exceptional person with a very warm and human attitude to all whom he met. His splendid organizational skills were recognized and respected by scientists and friends not only from all Balkan countries but also from all over the world. He was one of the true pioneers in a worldwide nephrology. Andrzej Więcek Goce Spasovski Janusz Ostrowski References: 1. Spasovski G., Stojceva-Taneva O.: Momir H. Polenakovic - Founder of the Nephrology Associations in the Republic of Macedonia. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2015, 36(2), 39-84. 2. Serafimoski V.: Contribution of Academician Momir Polenakovic to the Development of Nephrology in the Republic of Macedonia. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2015, 36(2), 19-37. 3. Spasovski G.: "Life is a Great Illusion, Achievements Stay Forever!" Momir H. Polenakovic (1939-2021) Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2021, 42(2), 25-26.
Figure 1. Professor Momir Polenakovic
Figure 2. Prof. Momir Polenakovic (right), Prof. Goce Spasovski
Professor Goce Spasovski University Department of Nephrology Medical Faculty University St. Cyril and Methodius, Skopje, N. Macedonia