Tag Archives: History

The Treatment of Kidney Failure in New Zealand

I am delighted to introduce a guest post from Dr Kelvin Lynn. Dr Lynn worked as a Nephrologist at Christchurch Hospital for 35 years and retired in 2015.  He is the lead author for a book just published:

The Treatment of Kidney Failure in New Zealand

Authors: Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace 2018

ISBN PDF – 978-0-473-45293-3

Available at no charge at www.kidneys.co.nz/Kidney-History from 16 October 2018.

Dr Kelvin Lynn and his fellow editors tell the history of the treatment of people with kidney failure in New Zealand; beginning in the early 1950s this story encompasses remarkable experiences of patients and their families, and of the contributions made by dedicated health professionals. It also reveals the challenges and ethics of meeting an ever-increasing demand for treatment.

New Zealand doctors were early adopters of new dialysis technology. The first peritoneal dialysis (PD treatment in New Zealand occurred at Wellington Hospital in 1954. Two young doctors tried a recently reported treatment using homemade equipment – classic Number 8 wire technology. Dr Neil Turnbull was a medical registrar in 1954 when he admitted a pale, vomiting, dehydrated 24-year-old woman who had not passed urine for the past nine days. Fifteen days before admission she had tried to terminate an unwanted pregnancy by infusing a Dettol solution into her cervical canal. In spite of rehydration with blood and five per cent glucose she became comatose. It was then that pathology registrar, Dr Dave Reid, suggested trying PD, which he had recently read about in the New England Journal of Medicine.  After mixing 20 litres of a glucose solution in sterilised glass bottles they had to stop as the solution had caramelised. They supposed the autoclave (steriliser) had been too hot and were proved right when after the autoclave temperature was reduced the new glucose solution remained clear. This was not the end of their technical problems, however, for after running two litres of the solution through the polythene tube that they had inserted into the right iliac fossa with a trocar and cannula, there was no drainage. Undeterred, they pulled the tube out and established good drainage by pricking holes in the tubing with a hot 22-gauge needle. After three days of peritoneal dialysis the patient began passing increasing volumes of urine and then regained consciousness. When last seen by Turnbull in 1992, she had normal renal function.

This book recounts the contribution of doctors, nurses, technicians, and patients and their families to the story of kidney treatment in New Zealand. Social and political changes in our country since the 1950s have critically influenced the development of treatment services for New Zealanders with kidney failure. The improvements in technology and community expectations regarding access to treatment over the past 50 years are discussed as well as the issues for patients and families coming to terms with kidney failure and its treatment.

This story is illustrated with many anecdotes and historical photographs.

  • The experience of living a life with kidney failure is recounted from patient interviews.These stories are a testament to the bravery and determination of these individuals. Rob Brydon’s story demonstrated what ordinary people were able to do in the face of kidney failure.

Rob began home haemodialysis on 31 August 1976 just after getting married. After two failed transplants, the second from his brother Nev, he remains on HHD over 40 years later.  Most of this time, he worked full-time. Following redundancy in 1993, he started his own painting business which he ran for ten years until he had both legs amputated below the knee, bringing this to an end. Rob had a profound anaemia as the result of having both his kidneys removed to control his high blood pressure. He built his own house while his haemoglobin concentration was only 40 to 50 g/L, and subsequently Rob was one of the first patients in New Zealand to benefit from erythropoietin treatment for renal anaemia. Rob remembers the burden of having to reuse dialysers and blood lines and the unpleasantness of using formalin for sterilisation. His advice to other dialysis patients is to “try to keep your life as normal as possible.”

  • There are chapters devoted to the professional development of renal nurses and dialysis technicians who have played a key role in the progress made in kidney treatment. Nurses were important members of the early clinical teams who pioneered dialysis treatment. Now renal nursing is an established nursing specialty. Hospital technicians who maintained the early dialysis equipment quickly took up clinical roles, particularly in training patients for dialysis at home.
  • There is an account of the trends and statistics of dialysis treatment in the past and a chapter discussing where dialysis treatment may go in the future.

The first home dialysis machine used in New Zealand Drake Willock 4011 1972

Enquiries to kidneyhistory@gmail.com

 

Glenn urinates in space

Well, it could have been the headline around the world 50 years ago.  One of my prized possessions is a copy of NASA’s report on the “First United States Manned Orbital Space Flight” which John Glenn flew 50 years ago this week.  The flight lasted about 5 hours, but that was plenty long enough for the NASA scientists to collect a bag of urine.  This may not seem exciting, but given they didn’t even know if he could pee normally, it was significant.

The report states:

“The inflight urine collection device contained 800 cubic centimeters of clear, straw-colored urien with a specific gravity of 1.016, pH 6.0, and was negative microscopically and for blood, protein, glucose and acetone.  This volume of urine was passed just prior to the retrosequence; bladder sensation and function while weightless was normal and unchanged from that of the customary 1g, group environment” (my italics)

Well, that was a relief…not being able to pee in space could have put an end to NASA’s plans to put someone on the moon.  Alternatively, Armstrong’s first words may have been….”That’s one small step for… dang I’m busting, hold on a minute……ahhhhhh…now, where was I?”  As it happens, it appears that Buzz Aldrin who accompanied Neil Armstrong that day was the first to pee on the moon.  In his book “Magnificent Desolation” (Bloomsbury 2009) he says as he paused coming down Eagles’s ladder after missing a rung: “I decided this would be an excellent opportunity to relieve the nervousness in my bladder.”

Back to John Glenn.  His success in urinating opened the door to exploring the far reaches of space.  It also cost NASA many millions as they never seem to have managed to design a toilet to work in the absence of gravity!

If anyone wants to read NASA’s report it is available in pdf format here:  Here are a few excerpts:

A brave beginning

Food depravation, occupation by fascist overlords, and decades before the invention of PCs and the blog are hardly conducive conditions for research, let alone major breakthroughs.  One man thought not.  Willem J Kolff, a physician in Kampden hospital in the Netherlands was perturbed by not being able to do anything for people who went into renal failure.  He knew, if he could just somehow get rid of the toxins for long enough for their kidney’s to recover he may save lives.  In 1943 he built and trailed a dialysis machine(1); – essentially a long tube (30 metres!) of cellophane through which the blood was pumped and what looks like a large washing machine where the urea waste products filtered out of the blood into a rinsing fluid (mainly tap water!).  One important innovation was the use of heparin to prevent blood clotting in the needles.

Miss S with what would now be called End Stage Renal Failure was the first patient.  At just 29 she was dying.   We know nothing more about her, but I salute her and her family for their contribution to science and, ultimately, to the saving of lives.  Miss S would undergo several dialysis sessions which proved that waste products could be removed artificially.  They were successful in preventing further accumulation of waste in her blood for 26 days. Unfortunately, she was terminally ill and died shortly afterwards.  As it turned out the first 15 patients all died.  The sixteenth, though, was the first to undergo dialysis and to live.  She had the acute form of renal failure (now called Acute Kidney Injury, or AKI).  AKI is my area of research and dialysis remains, after nearly 70 years, the only therapy available.

The lessons of the first dialysis machine don’t end at Willem Kolff’s persistence.  It is a wonderful example of cross-fertalisation of ideas.  The second author on the original paper was “H Th J Berk”, director of the Kampden Enamel works.  Berk was responsible for the idea of a horizontal “washing machine.”  Apparently the local Ford dealer provided the ideal pump – from a Model T! The nursing staff and technicians were indispensable.  One, Jan van Noordwijk, at least, found the job kept him out of the hands of the occupiers.

The Kolff Dialysis Machine immortalised in a dutch stamp

1.         Kolff WJ, Berk HT, Welle ter M, van der LEY AJ, van Dijk EC, van Noordwijk J. The artificial kidney: a dialyser with a great area. Acta Medica Scandinavia, vol. 8, p121ff, 1944 .