The development of pediatric nephrology.

Pediatric nephrology, as a discipline, arose from descriptive studies of childhood glomerulonephritis in Europe and the field of pediatric metabolism in the United States. While pediatric scientists before 1950 were concerned with fluid and electrolyte metabolism, regulation of intracellular and extracellular fluid, acid-base homeostasis, and parenteral fluid therapy, the defined field of nephrology developed after the Second World War around six major advances: ACTH and glucocorticoid therapy for nephrotic syndrome; renal biopsy to diagnose glomerular disease; the role of immunologic factors in glomerular injury; the use of dialysis as renal replacement therapy; renal transplantation as the optimal form of therapy in children with end stage renal failure; and recognition of renal disease in the etiology of 80% of cases of childhood hypertension. These discoveries led to focused research, the definition of specific training in nephrology, establishment of an American, European, and an International Society of Pediatric Nephrology, as well as an American Sub-Board of Pediatric Nephrology, and the inception of a journal, Pediatric Nephrology, now in its 15th year. Major research themes have included developmental nephrology, transplantation immunology, and concerns about growth in children with renal disease. Many clinical entities have been described in detail, some of which are almost confined to children. The scientific basis of pediatric nephrology, ongoing patient care needs, and its technical aspects - renal biopsy, dialysis and transplantation - assure its continuing future as a major pediatric discipline on all continents.