Board of the International Association for the History of Nephrology Ayse Balat – President Iwannis Stefanidis – Past President Davide Viggiano – President Elect Vincenzo Savica – Treasurer Natale G. De Santo - (ex officio) Councillors:

INTERNATIONAL NEPHROLOGICAL SYMPOSIUM DEVOTED TO THE MEMORY OF PROFESSOR MIROSLAV MYDLÍK (*1932 – †2018) SEPTEMBER 21 st , 2022, KOŠICE, SLOVAK REPUBLIC

The symposium was dedicated to the memory of Professor Miroslav Mydlík, MD, DSc., (Fig. 1) one of the leading medical personalities in Central Europe during the second half of the 20 th century, on the occasion of his 90 th birthday. The event was held under the auspices of Prof. RNDr. Pavol Sovák, CSc., Rector Magnificent, Pavol Jozef Šafárik University (UPJŠ), Košice, in its Historical Hall (Fig. 2b). The organizers invited Professor Mydlík‘s good friends and coworkers to the symposium. Two participants were from Italy, Professor Natale G. De Santo and Professor Guido Bellinghieri - both D.h.c. of Šafárik University, two were from Poland, Professor Janusz Ostrowski and his wife Maria and Professor Boleslaw Rutkowski. Five participants were from Slovakia – Ing. Katka Derzsiová, Ľuboslav Beňa, MD - Director of L. Pasteur Hospital, Košice, Professor Oliver Rácz, Ass. Professor Ivana Valočiková, Professor Ľudmila Podracká. All of them contributed with their lectures to the successful accomplishment of the event.

Figure 1. Professor Miroslav Mydlík, MD, DSc. July 21 st , 1932 - September 6 th , 2018

Figure 2b.: The Historical Hall of Pavol Jozef Šafárik University and Chorus Universitatis Šafarikianae

Figure 2a.: Opening of the Symposium. Presidium: sitting from left to right: Prof. Oliver Rácz, Prof. Pavol Jarčuška, Ing. Katarína Derzsiová, Ľuboslav Beňa, M.D.

Figure 3b: Dipl. Ing. Katka Derzsiová

Figure 3a: Professor Natale G. De Santo.

Figure 3d: Professor Boleslaw Rutkowski

Figure 3c: Professor Guido Bellinghieri

Figure 3e: Professor Janusz Ostrowski

Figure 4b: Ľuboslav Beňa, MD

Figure 4a: Professor Oliver Rácz

Figure 4d:Professor Ľudmila Podracká

Figure 4c: Ass. Professor Ivana Valočiková

Figure 5: The foreign participants and Katka Derzsiová at the grave of Prof. Mydlík in Rozália cemetery

Figure 7: Visit to the Vojtech Löffler Museum. From the left Professors: Oliver Rácz, Janusz Ostrowski, Boleslav Rutkowski, Natale De Santo, Guido Bellingheri and Ladislav Mirossay (former dean and rector of Šafárik University)

Figure 6: Some participants of the Symposium in front of the Vojtech Löffler Museum. In the background is the Cathedral of St. Elizabeth. From left to right: Ing. K. Derzsiová, Prof. O. Rácz, PhDr. Ž. Mácová (director of the Slovak Medical Society), M. Ostrowska, M.D.(wife of Prof. Ostrowski), JUDr. M. Mistríková (the lawyer of the Slovak Medical Society) and Prof. B. Rutkowski

Next day the guests completed a guided sightseeing tour of the city of Košice with PhDr. Milan Kolcún, a certified tourist guide in the city of Košice. During the sightseeing tour, the guests visited the underground archaeological museum Dolná Brána Košice. Lower Gate/Dolná Brána is the name for a complex of underground museum with the original entrance to the city and the original walls that stand out in the 2 nd half of the 13 th century and were revealed in 1996. Historian of the city of Košice, PhDr. Kolcún, explained to the participants the history of the city, which has been preserved in the museum. The next stop was at the Cathedral of St. Elizabeth. Our guests listened to a detailed explanation of the history of "The main Altar of St. Elizabeth's Cathedral." This scientific and cultural event was an appropriate tribute to the great physician, with honors not only as a scientist but also as an enthusiast in art and music. Following lectures where presented at the symposium. Katarína Derzsiová (Košice, Slovakia) in her lecture " Contribution of Professor Miroslav Mydlík, MD, DSc., to Science and Clinical Nephrology ", presented a brief biography and especially the clinical and scientific achievements of Professor Mydlík. He was very active as a physician, scientist, internist and nephrologist, especially in the field of renal replacement therapy in patients suffering from acute or chronic renal failure and with acute poisoning. He carried out the first hemoperfusion through active charcoal in the former Czechoslovakia (1977) and gradually introduced additional extracorporeal elimination methods and CAPD. He was: The Head of the Fourth Internal Clinic; founder and Head of the Nephrological Clinic of the University Hospital of L. Pasteur, the first in Slovakia; UPJŠ vice-rector; and principal expert for nephrology of the Ministry of Health of the Slovak Republic. In 2015 he was introduced into the "Hall of Glory of the Slovak Medicine". His lifelong literary interest was Franz Kafka's works. He left a historical impact on the field of nephrology in Slovakia, former Czechslovakia, and also on the international medical and scientific society. Natale G. De Santo (Naples, Italy) started his lecture with a very nice thoughts "Great men are like mountains. At their foot it is impossible to see their summit. It becomes visible when walking away from them." He adopted also the words of Jean Guitton, the most important Catholic philosopher of the last century in France, " The Friend has gone ": "The death of a friend generates a great vacuum. It is not just the vacuum of absentia which is irreparable too. It generates the feeling that part of ourselves lacks now approval, reflex, echo, and criticism. John´s Gospel renders in a simple and sublime way the distress of a person which is conscious that a fragment of his life is now settled in the past, because the friend has gone. One might say the whole gospel derives from this transformation of the time, which just for departure of a friend is turned in a time past, an old testament. I have experienced on many occasions the inexorable death of part of myself due to the death of another person.“ In his presentation “ Renal Stone Disease in Roman Pontiffs “ he pointed out recent studies that have shown that popes represent an interesting model to study kidney stone disease. Gout and uric acid stones affected 26 out of 264 popes (9.84%) reigning in the years 34 – 2005 AD. Eleven out of 264 popes were non-gouty, calcium(?) stone formers (4.1%). Why so many popes were stone formers? They consumed relatively higher amounts of animal protein and sodium. High protein intake causes hypercalciuria due to bone reabsorption, due to acid load, high filtered calcium load. Salt intake (urinary sodium), correlates with the prevalence of hypercalciuria, independently of intestinal Ca absorption and mainly via renal mechanism. Out of 26 popes with gout, 18 had kidney disease and 8 were without kidney disease. Age at death (Mean ± SEM) of 8 out 11 popes with kidney stones of non-gouty origin - of whom we know exactly the data of birth - was 63.1±2.66 years, significantly shorter (p<0.056) than that of popes with kidney stones of gouty origin who died at 73.2 ±3.02 years. De Santo concluded by explaining that popes had gout at a time when average people did not eat meat or drink alcohol. Now gout is disappeared from the Vatican Palaces, whereas the general population that has conquered the same papal life span, starts suffering of gout and kidney stone disease. It occurs in the population who did not accept to change their lifestyle. Guido Bellinghieri (Messina, Italy) proclaimed present difficulties of transplantation in his lecture “Organ Donation and Transplantation Today“. The shortage of organ donation and subsequent transplantation requires a great effort to increase the number of donors. Many important factors are needed to increase organ donation: cultural, religious, ethical and, above all, the congenital inclination towards donation. Organ donation offers one person to change the lives. All countries must work together in order to increase the number of organs available for patients requiring organ transplants by adopting well-specific programs. An important role must be played by the registries in providing data on organ donation, geographic distribution, transplant activities and outcomes. Lecture by Professor Janusz Ostrowski (Warsaw, Poland) with the title " Gustaw Piotrowski (1833 - 1884) - Discovery of Protein Reaction " was a celebration of the Polish physiologist G. Piotrowski, who independently of Ferdinand Rose described the Biuret reaction (1857). Biuret reaction it is one of the most commonly used reactions in protein chemistries and it is an important step in the diagnosis of renal disease. In 1857 he started working at the Department of Physiology of the Jagiellonian University and in 1860 he became its professor and Head. Gustaw Piotrowski also held the honorable functions of Dean and Rector of this University in Krakow. One of the first and most important was his work on the biuret reaction. Boleslaw Rutkowski (Gdańsk, Poland) in his lecture " Climate Changes and Kidney Disease " pointed out the negative impact of climate change on human health, the increased possibility of kidney damage due to lack of food and dehydration. All changes influencing the climate system are dependent on human influence and production of CO2 excess pollution from coal, natural gas and oil. Climate change through heat stress, storms, flooding, air pollution, food and water shortage are leading to increased morbidity and mortality mainly due to respiratory and cardiovascular diseases and malnutrition. Heat stroke coupled with increasing water shortage are increasing our risk for dehydration - associated with kidney disease including kidney stones, acute kidney injury and heat-stress CKD. CKD occurs especially in agricultural workers in hot and humid environments. Ľuboslav Beňa (Košice, Slovakia), in his presentation " Living Donor Kidney Transplantation (LDKT) " confirmed that this modality is considered as the best treatment option for patients with end stage renal disease. The main prerequisites for living kidney donation are (1) stable long-term kidney function in a donor and (2) safety of the donor nephrectomy. Between years 2015 and 2019, 81 LDCTs were performed in four Transplant Centers in Slovakia. 78 donors were included in the analysis of GFR with a mean follow-up of 3 ± 1.4 years. They evaluated the impact of predonation eGFR, age, and arterial hypertension on the severity of the change in eGFR after kidney donation. This study demonstrates a favorable course of donor nephrectomies as well as midterm clinical outcomes of the donors. However, long-term care and follow-up of living donors is necessary. Ivana Valočiková (Košice, Slovakia) pointed out in her presentation " Systemic Vasculitis – Latest Treatment Recommendations " on the latest recommended treatment of this disease. Systemic vasculitis comprises a spectrum of diseases affecting small and medium-sized vessels and can cause severe acute renal failure through glomerular, interstitial, and vascular damage. Granulomatosis with polyangiitis (GPA, former Wegener granulomatosis), microscopic polyangiitis (MP) and eosinophilic granulomatosis with polyangiitis (eGPA, former Churg-Strauss syndrome) are grouped under the term ANCA-associated vasculitis (AAV). AAV without immunosuppressive therapy is associated with poor prognosis. In 2021 KDIGO issued new recommendations for both induction and maintenance treatment. For new-onset AAV in induction treatment is recommended combination of glucocorticoids with cyclophosphamide or rituximab. Plasma exchange is recommended for patients with rapidly increasing CrS (˃ 500 μmol/L) and in persons with diffuse alveolar haemorrhage with hypoxemia. The lecture by Oliver Rácz (Košice) and Bertalan Fodor (Miskolc) " Current Trends in Laboratory Assessment of Renal Function " confirms that diabetic nephropathy is the most common cause of terminal kidney failure. Recently strong emphasis is put on early achievement of very good compensation as soon as possible after diagnosis also in type 2 diabetic patients similar to type 1. To achieve this aim, it is necessary to use reliable and simple markers of renal function. The basic level of renal function assessment remains the calculation of glomerular filtration rate and the estimation of albuminuria from serum creatinine. In the near future there is a need to replenish these basic markers with new biomarkers based on the latest results of genetic and epigenetic studies. Ľudmila Podracká et al. (Bratislava, Slovakia) pointed out in the lecture " Dynamics of Salivary Markers of Kidney Functions in Acute and Chronic Kidney Disease " that saliva can be used as an alternative diagnostic fluid enabling easy and non-invasive disease monitoring. Urea and creatinine can be measured in saliva and both were shown to be increased in renal failure. Authors monitored the dynamics of these parameters in AKI and CKD at different stages in animal and human models. Plasma and salivary concentrations of urea and creatinine correlated in children with renal failure, but not in controls. Saliva could be used for non-invasive monitoring in higher stages of AKI or CKD, rather than for screening of early stages of kidney diseases. Acknowledgements I am thankful to Professor Janusz Ostrowski, to Dionýz Kiss from the University Hospital of L. Pasteur, Košice, and to Mrs. Žofia Hnátová from the Faculty of Medicine of UPJŠ, Košice, for providing photographs from the Symposium.

48 th CONGRESS OF THE INTERNATIONAL SOCIETY FOR THE HISTORY OF MEDICINE

Figure 1.: The venue of the Congress

Figure 2. Frescoes on Orthodox Chuches.

Professor Baran should also be deeply thanked for her persistence to organize a Joint ISHM-IAHN Session according to the agreement between the two Bodies signed in Larissa Greece 2020 by Professor Janusz Ostrowski and myself (on behalf of Professor Carlos Viesca). In the Iasi Congress the following papers were read by IAHN Members: A) Prof. Dr. Natale Gaspare de Santo presented three topics. 1) For the history of sleep apnea in kidney disease. He elaborated on some abnormalities caused by SA. Indicatively, hypoxemia and oxidative stress as associated with diabetes mellitus, cardiovascular morbidity and mortality. SA is not cured by dialysis or peritoneal dialysis; is cured by nocturnal daily hemodialysis and by cycler assisted peritoneal dialysis and is ameliorated, but not cured, by transplantation probably for the fact that the transplanted kidney is denervated; It is cured by CPAP. 2) Malaria, A Papal disease. His paper started with malaria’s first appearance in Venice in the XV continued with the stories of all Popes affected by the disease from the early periods of the Papacy till a century ago. Rome and the Pontine plain have been malarial sites. So being pope and obliged to reside in Rome represented a risk factor for contracting the disease. 3). Septic acute kidney injury, a leading cause of 20 Papal deaths in the years 1277-2005. This study found that a total of 21 of 78 popes (26.9%) reigning between the years 1277-2005, died of AKI. Sepsis was identified as the leading cause of Acute Kidney Injury and death in 20 of these 21 (95.2%) popes. Age at death of the 21 popes was 69.4±2.26 years B) Prof. Diamandopoulos Athanasios presented four papers in the Iasi Congress. Two of them were introductions to specific sessions incorporated in the Congress. One of them was the Joint ISHM/IAHN Session where he presented the paper: 1) Nephrology as a craft and not as a science, according to some Hippocratic writings. It was about Hippocrates’ relation of cooking with the regulation of a balanced internal mileu of a healthy and an ill person. The paper elaborated on its application to achieving a normal pH of a human either by giving neutralizing agents or by subtracting damaging ones. The second specific session was devoted to the celebrations of the 800 years’ anniversary of the Padua University. In this session the paper: 2) The links between the Medical school of Padua and the Hellenic Medical World was presented. It reported the lives and works of ten famous medical doctors and politicians of Greek origin who studied in Padua during the 17 th and 18 th centuries. In the main Congress he presented two more papers: 3) Two different ideologies between the bodies’ cremation in the past and during the current times. His conclusions were that since Homer till very recently in India cremating pyres had always a religious content. In modern times they are gradually losing it reaching a covered or not atheistic element. 4) Debunking the myths about Hippocrates. The author debunks several urban myths about Hippocrates’ lack of faith, his patriotism, his teaching under the Cos Plane Tree, even the authorship of the Oath. He further discusses the modern political, social and cultural climate that is against the Hippocratic principles and underscores his belief that only a few devoted physicians and Societies could still adhere to the Oath. C) Professor Ioannis Stefanidis presented: 1) Kidney disease in “Physica” by Hildegard von Bingen (1098-1179). Hildegard von Bingen (Hildegardis Bingensis; Saint Hildegard) also known as or “Sibyl of the Rhine” (1098–1179 AD), was a Benedictine abbess, musician, poet, writer, counselor and healer. Hildegard von Bingen’s medical work is collected in two books (1152-1163 AD): “Physica” and “Causae et curae”. The aim of this paper was to investigate the characteristics of the nephrology oriented remedies in “Physica” and compare them with the respective remedies in “de Materia Medica” (1st cent AD) by Dioscorides Pedanios Anazarbeus. “Physica” is a collection of nine books with an inventory of plants, trees, elements, stones, animals, and metals, describing their natural therapeutic properties. Among all plants there were 15 (5.1%) of nephrological interest (11 within the section of plants and 4 within the section of trees). Only some of the natural ingredients were found with the same indication in the ancient text (9 out of 15). The nephrological treatment indications found included dysuria, nephritic pain and lithiasis in 87% and dropsy (oedema) in 13.0% - comparable with 10% in the Materia Medica. D) Professor Ayse Balat also presented one paper: 1) A study on urinary system’s anatomy knowledge and illustrations in the 17th century Turkish anatomy book Tashrīḥ al-abdān wa tarjamān qıbāla faylasūfān by shams al-dīn ʿiṭāqī. Starting from ancient times, information about human anatomy has been given either as a part of medical works or independent works have been written on this subject. Shams al-dīn ʿIṭāqī’s Tashrīḥ al-abdān wa tarjamān ḳıbāla faylasūfān (1632) was an illustrated Turkish book written exclusively on anatomy in the 17th century. Aim of this study was to evaluate both anatomical knowledge and figures on urinary system and to comment on achieved results. Tashrīḥ al-abdān wa tarjamān qibāla faylasūfān with its some Eastern and European style illustrations, can be estimated as the bridging work between Ottoman and European treatises on human anatomy

PRO PATRIA ET HUMANITATE

Figure 1. The title page of the Conference programme.

Figure 2. Exhibition Pro Patria et Humanitate. From the left: prof. Janusz Ostrowski, prof. Jarosław Pinkas (photo Maria Ostrowska)

Figure 3. Prof. Janusz Ostrowski during the lecture (photo Jarosław Pinkas)

PROGRESS IN NEPHROLOGY AND HYPERTATION

Nephrology, a new field of science within internal medicine, began to emerge in Poland in the mid-twentieth century. In 1958, the first nephrology clinic was established in Wrocław, followed by other academic centres in the early 1970s. In the 1960s, the Nephrology Section started functioning within the Society of Polish Internists, and the first conferences in nephrology began to appear. In 1983, several renowned Polish nephrologists led by Profs. Franciszek Kokot and Zenon Szewczyk set up the Polish Society of Nephrology (PTN) in Bydgoszcz with the task of holding national scientific and training conferences every year and election conventions every three years. Simultaneously, PTN branches organising local conferences started to stem. Some of those small-scale meetings later grew into national scientific events held partly independently of the PTN. These include the Katowice Seminars Progress in Nephrology and Hypertension , the Post ASN Meeting in Gdańsk, or Top Nephrological Trends in Poznań. Here, however, we will only talk about the Seminar in Katowice, which occupies a unique place on the scientific and training map of nephrology and hypertension. In 2000, following prof. Franciszek Kokot's retirement, the management of the Department and Clinic of Nephrology, Endocrinology and Metabolic Diseases of the Medical University of Silesia was taken over by his natural successor and one of the many outstanding students, prof. Andrzej Więcek (Fig. 1). Currently, the clinic is called the Department and Clinic of Nephrology, Transplantation and Internal Diseases of the Medical University of Silesia in Katowice. Though probably conceived of much earlier, one of A. Więcek's initiatives as its Head was the organisation of the Katowice Seminar Progress in Nephrology and Hypertension. The initiative was undoubtedly inspired by the seminars run in Heidelberg, Germany, by prof. Eberhard Ritz widely known for his close scientific and personal relationship with the staff of the centre of nephrology in Katowice. Professor Ritz is one of the most internationally recognised nephrologists, who has attended most of the Seminars and was a member of its Scientific Committee (Fig. 2).

Figure 2. Professor Eberhard Ritz (photo Janusz Ostrowski)

Figure 1. Professor Andrzej Więcek (photo Janusz Ostrowski)

Professor A. Więcek intended to have a three-day-long annual scientific meeting, during which the most burning issues of broadly-understood nephrology and hypertension would be presented by renowned Polish and foreign experts in the fields. The discussions are intended mainly for specialists in the field of nephrology, transplantation medicine and hypertension, and the main topics include clinical nephrology, dialysis, organ (kidney) transplantation and all the aspects of hypertension. The first Katowice Seminar was held on 8-10 November 2001. This year, the 22 nd Katowice Seminar took place on 24-26 November with the active participation of several members of the International Association for the History of Nephrology (IAHN) (Fig 3). The first of them was prof. Przemysław Rutkowski, a former member of the IAHN Board, who presented a lecture on Heart insufficiency in chronic kidney disease (Fig. 4). Then, on the same day, Prof. Janusz Ostrowski gave a typically historical speech entitled Great epidemics over the centuries (Fig. 5). Additionally, Prof. Bolesław Rutkowski, the former President and an honorary member of our society, and prof. J Ostrowski chaired scientific sessions (Fig. 6).

Figure 4. Professor Przemysław Rutkowski during his lecture (photo Janusz Ostrowski)

Figure 3. From the left: prof. Piotr Jankowski, prof. Ryszard Gellert, prof. Janusz Ostrowski (photo Maria Ostrowska)

Figure 6. Professor Janusz Ostrowski during his lecture (photo Maria Ostrowska)

Figure 5. Professor Janusz Ostrowski as the chair of a session (photo Maria Ostrowska)

EDITORIAL COMMENT ON THE ANALYSIS BY PROFESSOR ATHANASIOS DIAMANDOPOULOS ON IAHN ACTIVITIES

We have received an interesting analysis by prof Diamandopoulos about the activities of our Association, presented in Vienna in 2016. These represent an excellent snapshot of IAHN activities up to five years ago. While awaiting an update about the editorial production of IAHN in 2016-2022, it is helpful to rethink our scientific interests, how these have been changed over time, and where we are going. Therefore, I thank prof Diamandopoulos for this helpful analysis, which deserves a comment from the Editors because they can guide the future activities of the association. According to prof Diamandopoulos’ analysis, In the period 1997-2016, IAHN has produced 363 papers, which have been published in two major journals: American Journal of Nephrology and Journal of Nephrology. The association also participated in the ERA-EDTA Congresses with several abstracts. We can say this high productivity has maintained up today, as evidenced by our website. The manuscripts came from different nations, which underlines the international nature of the association. The two graphs reported in Figure 1 are fascinating to us.

Figure 1. Two graphs (slightly modified) from prof Diamandopoulos’s presentation at IAHN meeting in Vienna 2016 (courtesy of prof Diamandopoulos).

On one side, we recognize a strong trend in our community towards biographical descriptions in the History of Nephrology. Biographic data of crucial persons in the history of nephrology are very important for the historian who seeks to understand how a specific theory was developed over time and what has helped a scientist to arrive at a groundbreaking experiment or a breakthrough idea. Compiling biographical data is a highly time-consuming task, as it requires the analysis of several sources (sometimes contradictory) to gather objective information about the life of a person and his/her role in a field of study. Comparing the second graph in Figure 1, we can also understand that many of these biographical data pertain to modern scientists or nephrologists. Again, this is a remarkable peculiarity of our society, as many of our members feel the importance of reporting information about great nephrologists who have been fundamental in developing some aspects of nephrology in a specific country. An overview of these manuscripts suggests that, in many cases, the authors knew the scientist personally in the bibliographic account, thus adding their own experience with the subject. This, indeed, is very valuable for the historians of the future, who will find a collection of information from people who personally knew the subject of the biographic study. In perspective, it would be nice if our community devoted time to improving the biographic accounts found on Wikipedia and which usually represent the first source to retrieve (freely and rapidly) information about a specific scientist or famous physician. I think that two other aspects are interesting: 1) fewer manuscripts from IAHN have analyzed science in the renaissance and ancient times. While the analysis of nephrological aspects in ancient times is limited by the scant sources and possibly some lack of attention towards the kidneys in ancient times, the renaissance manuscripts certainly deserve much more attention from our community as they contain a large amount of material (usually in Latin) and may offer insights about "atypical" medical views which might have preceded (and possibly inspire) non-Galenic positions in subsequent periods. We should also take advantage of the availability of some of these manuscripts in the web and from the excellent performance of Google Translate in translating from Latin; 2) in the classification of Fig 1 there is no tag for “mechanisms of discovery” or “epistemiology” or “nosology”. Obviously, there have been publications by IAHN dealing with these aspects, but I like to remark on how this item is very important for the modern nephrological sciences. Modern science is often inclined at proposing theories, classifications, or treatments without noticing that these have been already proposed in the past. One example is the diet in nephrological patients or the role of uric acid. Another example is the modern classification of shock into dry/wet and warm/cold, which resembles Galenic notions. I feel that the studies produced by IAHN would be greatly helpful to the modern scientist if only he/she understands how to use these historical notions: I do not see why the historian (and particularly the historian nephrologist) should not guide the reader in this direction at least in the abstract of a historical study. I like to conclude by quoting part of the nice letter from prof Diamandopoulos: “[…] I attach the illustrations for a lecture delivered by me during the IAHN Vienna Meeting. Later, it was inserted in the section "library" in our website as it was thought that it was giving a quick answer to the readers about the overall scientific profile of the Association. […] As I think that numbers have a soul, as elegantly expressed by the following extract: On numbers In writing the history of nephrology, as in most histories of science, numbers are strong signals, are precise, never emphatic, do not lie, and express our rational soul. Numbers have a ”heart and a soul” and “allow us to answer the question who are we?, they are what allows us to make ourselves identified” [1]. [1]Napoletano R. L’altra Domenica I Radio 24. Il sole 24ore.21/11/2015, p.23, col.1-2 ”

ON THE VOCATION OF THE SCHOLAR: HOW YOUTUBE HELPS TO SATISFY FICHTE'S REQUESTS

Johann Gottlieb Fichte (1762-1814), in “The Vocation of the scholar”, developed his accounts on the role of the scholar in society, his social function: the scholar has the moral duty of furthering human culture and progress; to do this the scholar must also possess historical knowledge. I find this position inspirational for my work, and maybe it gives an additional view of our History of Nephrology Association: not only delving with the advancement of historical knowledge but also actively spreading it in society. Indeed, today there is a strong tendency to encourage scientists to exit from their laboratories and libraries, and to encounter the "great public", so that everyone knows how science work, why specific experiments are needed, what are the limitations of science, and the like. The European Association of Nephrology follows this trend, with many initiatives towards the non-nephrological community. The "world kidney day" is another example of this attempt (https://www.worldkidneyday.org/). Within this tendency, I like to report what the History of Medicine division of the National Library of Medicine has organized. As the reader may know, the National Library of Medicine (NLM) is a part of the American National Institute of Health (NIH). It is an organism started in 1836 and today is "the world’s largest biomedical library and a leader in research in computational health informatics". Pubmed (probably the most used search engine in the world of science) is a product of the NLM. It has a division of History of Medicine (HMD). On its website, the HMD gives access to manuscripts, films, photographs, and rare books ( https://www.nlm.nih.gov/hmd/index.html ), a collection of wonderful material for the historian. Here I want to underline, however, how HMD takes care to its social mission: this division has created an entire set of videos, available on Youtube, called "NLM history talks". The interested reader can see the videos at the following link: https://www.youtube.com/@NLMNIH/videos The NLM is not the only organization that gives attention to its social role using the Youtube channels: the International Society of Nephrology (ISN) goes in the same direction with a specific Youtube channel called "Nephrology Video Legacy Project". This channel, hosted on Youtube, counts 187 videos curated by Kim Solez and J Stewart Cameron, with modern and ancient interviews with many scholars in the field of Nephrology. Here is the link to the channel: https://www.youtube.com/@KimSolez If only I could express a desire before Christmas regarding our Association, it would be to have available the innumerable high-quality lectures and the precious historical material presented over the years during our meetings, similar to the example of NLM. This, of course, would require time and dedication; however, this would be compensated by the role that our Association would have in society, transmitting to a more enormous public not only the passion for History (and history of nephrology in particular), but also giving instruments to young students and doctors to understand better where we are today and how we did arrive there. Davide Viggiano

THE “UNGRATEFUL” FACE OF MEDICINE.

The history of medicine is a series of great achievements and epic mistakes. Personally, I cannot say which is more but the continuous progress of medicine suggests at least a "kind" of balance between them. Medicine is also full of twists and turns concerning mainly treatment modalities. Nephrology as a “fledgling” speciality that is still being structured and maturing could not be an exception. Treatment of acute kidney injury (AKI) and of end-stage kidney disease (ESKD) includes two dialysis options, haemodialysis (HD) and peritoneal dialysis (PD). Studies from Europe and North America indicate that more than two-thirds of incident patients do not have a medical contraindication for either HD or PD. Nephrologists estimate that roughly half of the patients with ESKD are good candidates for PD and patients strongly prefer PD when given the option(1). A significant subset of ESKD patients do not receive pre-ESKD education or access planning and the majority of them (sometimes referred to as “crash ESKD”) are treated with urgent-start HD through a central venous catheter(2). On the other hand, acute PD as a modality to treat AKI has become underutilized due to the lack of familiarity of nephrologists with the use of PD in the acute setting and the perception that PD portends inadequate clearance and ultrafiltration. Although survival benefits for HD over PD have not been demonstrated, and considering that PD is more cost- effective in developed countries studies, one would expect to see increasing rates of PD use. However, studies and registries have reported a decrease in the percentage of PD utilization(3). Worldwide, PD accounts for 9% of all kidney replacement therapy (KRT) and 11% of all dialysis and more than half of all patients receiving PD resided in four countries (China, USA, Mexico and Thailand)(4). Nevertheless, PD use has decreased worldwide and has been extremely limited in North America and Europe (5).

The reasons for this underutilization may be a lack of familiarity with the technique by nephrologists, intensivists and nursing staff, and the ease of ordering CVVH by the physicians. Surveys of US academic medical centers indicated that they do not devote enough time for fellows to develop expertise in the care of PD patients. More than half of practicing nephrologists in the USA reported that they were trained mainly in providing care for HD(6). Unease about the certainty of ultrafiltration and clearance potential and misconceptions regarding complications or effectiveness despite many positive trials may also contribute to a reluctant use of PD. The decline of PD cannot be explained only by medical reasons but by management and health care policies also. The rapid increase in the number of HD facilities, expansion of the preexisting clinics by increasing the number of HD units, and increase in the number of HD shifts or overnight shifts have led to greater use of HD. Whatever the causes, this has resulted in a downward spiral where the loss of experience and insufficient knowledge on important pathophysiological issues of PD modality, and healthcare strategies have resulted in almost exclusive attention to HD and an “ungrateful” attitude to PD, a dialysis modality that has “faithfully” served and continues to serve the needs of kidney patients. But life is unpredictable and twists and turns are not unusual; the most striking example is the Covid-19 pandemic which created an unprecedented strain on healthcare systems around the world. The Covid pandemic pushed the medical world to its limits by challenging conventional approaches and exhausting resources. It has forced us to face the reality and recruit pre-existing options, like PD that we have previously ignored and underutilized. AKI is one of the most serious complications of Covid-19 and a major determinant of resource utilization, especially if renal replacement therapy is required(7). High rates of AKI were reported in Italy and New York. The dramatic Covid surge in March 2020 in New York City threatened to overwhelm hospital capacity for kidney replacement therapy provision (KRT)(8). The growing number of AKI patients in combination with a limited pool of trained staff, scarce supplies of continuous replacement therapy, and higher rate of clotting overwhelmed our typically used dialysis modalities and dictated quick and creative problem-solving. To offset these shortages the “ungrateful” nephrologists started to renew their interest in using "the abandoned PD" for AKI treatment. Suddenly, PD seemed the only solution to manage the anticipated increased needs for KRT and the best option to rapidly expand the capacity to provide adequate and life-saving therapy. The "forgotten PD" proved to be a lifesaving dialysis option and the only way to respond to the growing demands for dialysis services even under “unfavourable” conditions such as bedside catheter placement, prone positioning, and obese patients. Despite the severity of the illness and challenges in delivering PD, similar rates of death and recovery to those of AKI patients of other cohorts were reported in studies(8,9). The recent pandemic made the nephrology community reconsider its “ungrateful” attitude toward a dialysis option which proved to be lifesaving during this, and maybe to other, future natural disasters. PD continuously serves kidney patients' needs during the most crucial phases of their lives: childhood and elderhood giving them the chance to start and end a life with autonomy, respect and dignity. We owe PD and may the abovementioned facts pave the way to a place of respect it deserves. References: 1. Sloan CE, Coffman CJ, Sanders LL, Maciejewski ML, Lee SD, Hirth RA, Wang V. Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform. Clin J Am Soc Nephrol. 2019 Dec 6;14(12):1763-1772. 2. United States Renal Data System Annual Data Report (USRDS) Available from: https://www.usrds.org/annual-data-report/current-adr/ Accessed 2020 Oct 15. 3. Van de Luijtgaarden MW, Jager KJ, Segelmark M, et al:Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period. Nephrol Dial Transplant. 2016 Jan;31(1):120-8. doi: 10.1093/ndt/gfv295. Epub 2015 Aug 26. 4. Bello, A.K., Okpechi, I.G., Osman, M.A. et al. Epidemiology of peritoneal dialysis outcomes. Nat Rev Nephrol 18, 779–793 (2022). 5. ERA Registry Annual Report 2020 6. Thamer M, Hwang W, Fink NE, Sadler JH, Wills S, Levin N, Bass EB, Levey AS, Brookmeyer R, Powe NR: US nephrologists’ recommendation of dialysis modality: Results of a national survey. Am J Kidney Dis36 :1155– 1165,2000. 7. Sabaghian, T., Kharazmi, A. B., Ansari, A., et al : (2022). COVID-19 and Acute Kidney Injury: A Systematic Review. Frontiers in Medicine, 9. 8. Chen W, Caplin N, El Shamy O, et al ; NYC-PD Consortium. Use of peritoneal dialysis for acute kidney injury during the COVID-19 pandemic in New York City: a multicenter observational study. Kidney Int. 2021 Jul;100(1):2-5. 9. NinaJ. Caplin, Olga Zhdanova, Manish Tandon, et al . Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City. Kidney360 Dec 2020, 1 (12) 1345-1352