When were the first kidney biopsies performed?
Biopsies of the kidney on the operating table were performed by surgeons through the first decades of the 20th century for various reasons. Relevant to the history of nephrology was an open biopsy performed in 1896 by a British urologist, Reginald Harrison (1837–1908), as part of a kidney decapsulation procedure for the treatment of Bright disease. The first open kidney biopsy for a diagnostic purpose was performed in 1923 in Toronto by Norman B. Gwyn (1875–1952), a nephew and student of William Osler. The first report of systematically studied kidney biopsies was in subjects undergoing dorsolumbar sympathectomy for hypertension published in 1943 by a Boston surgeon, Reginald Smithwick (1899–1987), and a pathologist, Benjamin Castleman (1906–1982), better known for his long editorship of the clinicopathologic case reports in the New England Journal of Medicine .
Percutaneous needle biopsy of the kidney was introduced after the successful use of cutting needles in liver biopsy. Nils Alwall (1904–1986) of Lund, also a pioneer of hemodialysis, performed the first systematic needle kidney biopsies in 1944. An early death of a patient after a biopsy led him to abandon the technique. He did not publish his results until 1952. In the meantime, Poul Iversen (1889–1966) and Claus Brun (1914–2014) of Copenhagen began using the technique in 1949. The initial needles, known as Vim-Silverman needles, were a modification of the liver biopsy cutting-edge needles. Apart from the skill needed in handling these needles, positioning of the kidney presented a major challenge in those early days. Credit for improvements and for popularizing the clinical utility of kidney biopsies is due to Robert M. Kark (1911–2002), Robert C. Muehrcke (1921–2003), and Conrad L. Pirani (1915–2005) from Chicago. The first international meeting on kidney biopsies was held in 1961, and meetings to discuss kidney pathology were precursors of the kidney pathology societies that emerged thereafter.
Subsequent improved imaging and kidney ultrasound, together with new disposable gun biopsy needles, have literally revolutionized the procedure, which has evolved increasingly into another procedure undertaken by invasive radiologists.