History of kidney transplantation in Poland

The first successful cadaveric kidney transplantation in Poland was performed in Medical University in Warsaw on January 26th 1966 by professor Jan Nielubowicz and his team (Waldemar Olszewski, Jerzy Szczerbań i Wojciech Rowiński). The recipient 18 year-old nursing school student had been prepared and taken care afterwards by nephrologists Professor Tadeusz Orłowski and his team. The operation went well and the patient was discharged home 3 weeks after transplantation. The patient died 6 months later with well functioning graft due to acute pancreatitis (1, 2). Soon after Professor Wiktor Bross in Wrocław performed the first in Poland kidney transplantation from living related donor on March 31st 1966. At the time when the first cadaveric kidney transplantation was performed in Poland the World Registry organized by professor Joseph Murray recorded only 600 such procedures in the world. It was a great success of polish medicine. This was followed by some attempts in other centres which however were abandoned very soon and the program until eighties was continued in Warsaw only. The surgical team had been preparing to start the clinical transplantation program for over two preceding years in Surgical Research Laboratory headed by prof. Jan Nielubowicz. Prof. Wojciech Rowiński learned transplantation medicine as research fellow in Peter bent Brigham Hospital in Boston in 1965. 1967 laboratory In Warsaw Transplant Centre produced anti-dog, anti-rat, anti-human anti-lymphocytic sera (ALS) and purified globulins in horses, goats, pigs and rabbits. Evaluation of effect of administration of ALS on renal graft survival in dogs was preformed. The team one of the first in the world prepared rabbit-anti-thymocyte serum used in transplant patients (3, 4).
Up to 1976 some 80 cadaver (10-12 per year) and several living related donor kidney transplantations were performed. Since 1977 the number of kidney transplantations in Poland slowly increased to 40-46 per year (5, 6). The legal limitations were not helpful. Cadaveric kidneys procurement was considered as an element of post-mortem examinations. The diagnosis of brain death was well known but not legally permissible. Harvesting of the kidneys was done after cardiac arrest which resulted of high rate of ischemic injury of the organ. At early eighties revival of transplantation programs in other Medical School hospitals: Wrocław, Katowice, Gdańsk, Kraków, Szczecin was started. In Warsaw in addition to Department of Vascular Surgery and Transplantlogy (headed by prof. Nielubowicz, thereafter by prof. Jacek Szmidt) two other transplant centres were set up; Department of General and Transplantation Surgery (1983 headed by prof. Wojciech Rowiński) and Children’s Memorial Health Institute where the first cadaveric kidney transplantation was performed in 1984 by prof. Wojciech Kamiński and prof. Czesław Szymkiewicz. In 1985 the first kidney transplantation from living donor was done. The forth transplant centre in Warsaw was established in Hospital of Internal Affairs in 1990 headed by prof. Marek Durlik (7, 8).
Professor Tadeusz Orłowski created in 1975 the Transplantation Institute in Warsaw Medical University which consisted of two medical departments and department of experimental immunology with the tissue typing laboratory. The pretransplant assessment and the posttransplantation care including immunological monitoring were done in Institute. Both surgical transplant units closely cooperated with Institute. For several years Transplantation Institute was the leading transplant centre in Poland. In 1987 the new protocol originally developed in the Transplantation Institute showed that addition of promethazine to standard immunosuppression (befroe CsA era) resulted in better graft survival (9).
Regarding legal regulations of organ retrieval Transplant Act on Cells, Tissues and Organ Retrieval and Transplantation was issued by Parliament and signed by President in 1995. It was updated in 2005. The act approved presumed consent for organ retrieval, regulateed living donor organ donation, penalized commerce in organ transplantation. In 1993 National Transplantation Council was established by Ministry of Health, main tasks of this advisory body were to elaboration of strategy for development of tissue and organ transplantation, popularisation of the idea of organ donation and transplantation among general public, education of medical students and staff in organ donation and transplantation, active participation in creating legal regulations concerning organ and tissue transplantation. POLTRANSPLANT- Polish Organ Procurement and Sharing Organization was established in 1996 ( headed by prof. Janusz Wałaszewski), National Specialist in the Field of Clinical Transplantation (prof. Wojciech Rowiński) as executive body was appointed in 1996 (10, 11). In 1993 the Polish Transplantation Society was established, the first President was elected prof. Mieczysław Lao head of the Transplantation Institute in Warsaw.
In the early 80-ties kidney transplantation programs were started in a number of Medical School hospitals across the country.
In Wroclaw renewal of transplant program was started in 1983 by the surgeon prof. Klemens Skóra and nephrologist prof. Zenon Szewczyk. Since 1989 one hundred cadaveric kidney transplants were performed. In 1988 second transplant centre in Voivodship Hospital was created headed by prof. Wojciech Witkiewicz (12).
The first two kidney transplantations from living related donors in Upper Silesia region were performed in 1966 (September, November) by doctor Józef Gasiński in hospital in Bytom in cooperation with nephrologist prof. Zbylut Twardowski. Both recipients died due to sepsis after 28 and 136 days respectively. Renewal of transplant program was started in Department of General Surgery in Medical University in Katowice. In 1983 prof. Roman Kurzbauer performer 4 cadaveric kidney transplants, all of them failed due to infectious complications. Under new head of Department of General Surgery prof. Stanisława Kuśmierskiego with cooperation with Nephrology Department headed by prof. Franciszek Kokot in 1984-1990 more than 200 kidney transplantation were performed (12).
In Krakow 9 kidney transplantations (one from living donor) were performed by doctor Romuald Drop, first in march 1975. The responsible nephrologist was prof. Zygmunt Hanicki. In 1992 renewal of transplant program was reported by prof. Tadeusz Popiela and doctor Jerzy Bucki in cooperation with nephrologist prof. Władysław Sułowicz (12).
In Gdańsk the first kidney transplantation in Medical University was done on 31st August 1980 by prof. Wojciech Gacyk and prof. Jerzy Dybicki in cooperation with Department of Nephrology headed by Andrzej Manitius thereafter by prof. Bolesław Rutkowski (12).
In Szczecin the first kidney transplantation was performed in 1980 in II Department of Surgery in medical University by prof. Stansisław Zieliński. The second transplant centre in Szczecin was established in 1983 in Voivodship Hospital by doctor Marek Umiński, prof. Marek Ostrowski and doctor Janusz Lapis (12).
In the Białystok Medical University the first kidney transplantation was performed in 1989 by prof. Stanisław Głowiński with help of prof Jacek Szmidt from Warsaw in cooperation with Department of Nephrology headed by prof. Michał Myśliwiec (12).
In Poznan in Medical University the first kidney transplantation was performed in 1985 in Department of General Surgery and Gastroenterology by prof. Adam Deja in cooperation with prof. Maciej Krzymański and prof. Andrzej Oko from the Department of Nephrology. The second transplant centre was created in Poznań in 1994 in Voivodship Hospital by prof. Zbigniew Włodarczyk, Konstanty Tukałło, Adam Deja and Maciej Głyda (12).
In Łódź two transplant centres started their activity in 1996, first inthe Medical University in Department of Surgery heade by prof. Janusz Wasiak and prof. Janusz Strzelczyk in cooperation with prof. Witold Chrzanowski from Department of Nephrology, second in Pirogow Voivodship Hospital headed by prof. Józef Matych (12).
In Lublin transplant program was started in 1994 inthe Medical University by prof. M.Jesipowicz, prof. S.Stettner, and prof. S.Rudzki in cooperation with prof. Andrzej Książek, head of the Department of Nephrology (12).
In Bydgoszcz prof. Zbigniew Włodarczyk created new transplant centre in 2000 year.
The youngest transplant centre was established in Olsztyn in 2010 by prof. Wojciech Rowiński and doctor Andrzej Kobryń (12).
During the 51 years since first renal transplantation until December 31st 2016 the total number of 22,658 kidney from deceased donor and 766 kidney from living donor transplantations were performed in Poland. Currently there are 21 kidney transplant centres performing 1000 transplants per year in Poland (13).

References:

  1. Orlowski T, Nielubowicz J, Gradowska L, Rowiński W, Klopotowska E. (1966) Function of a transplanted kidney. Pol Arch Med Wewn. 37(1):47-54. Polish. PubMed PMID: 5330481
  2. Nielubowicz J, Orlowski T, Rowiński W, Szczerbań J, Szostek M, Kamiński B, Olszewski W, Ladygin J, Lao M, Gradowska L. (1966) Transplantation of kidney from cadaver. Pol Przegl Chir. 38(10):1030-4. Polish. PubMed PMID: 5341716
  3. Rowiński W, Szmidt J, Rosnowska M, Baraniewski H, Grupińska E, Tupalska B, Brühl A, Krawczyński K, Madaliński K, Nowoslawski A. (1970) Effect of long-term administration of horse antilymphocyte serum to healthy dogs. Pol Arch Med Wewn. 45(2):281-9. Polish. PubMed PMID: 5471505
  4. Rowiński W, Szmidt J, Brühl A, Dziedziul S, Tupalska B, Baraniewski H, Grupińska E, Opertowski A, Nielubowicz J. (1970) Production and titration of antilymphocyte serum for use in dogs. Pol Arch Med Wewn. 45(2):275-80. Polish. PubMed PMID: 4919365
  5. Nielubowicz J, Orlowski T, Wesolowski S, Falda Z, Gradowska L, Rowińska D, Rowiński W, Skośkiewicz M, Szostek M, Filipowicz Z, Glyda J, Goliszek Z, Jedrzejewski R, Kardasiewicz W, Klepacka J, Klopotowska E, Kossowska B, Koziak H, Krzywicka E, Lao M, Ladygin J, Marzinek B, Miller J, Michalowicz B, Machowski Z, Olszewski K. (1970) Results of kidney transplantation in the Warsaw center. Pol Arch Med Wewn. 45(2):175-8. Polish. PubMed PMID: 4919357
  6. Rowiński W. (1970) Results of kidney transplantation in Poland. Pol Arch Med Wewn. 45(2):267-73. Polish. PubMed PMID: 4919364
  7. Rowiński W. (1996) History of organ transplantation in Warsaw. A personal perspective. Ann Transplant. 1(1):5-8. PubMed PMID: 9869929
  8. Lao M, Gradowska L, Stryjecka-Rowińska D, Szmidt J, Rowiński W, Wałaszewski J. (1997) Kidney transplantation in Warsaw and Poland in the years 1966-1996. Pol Arch Med Wewn. 98(10):294-303. Polish. PubMed PMID: 9557082
  9. Orłowski T, Gaciong Z, Paczek L. Promethazine.(1987) results of triple-drug immunosuppression for kidney transplantation. Transplant Proc. 1987 Feb;19(1 Pt 3):2124-5. PubMed PMID: 3079074
  10. Rowiński W, Lao M, Wałaszewski J, Lisik W. (1996) Social, legal and medical limitations of organ transplantation in Poland. Ann Transplant. 1(3):36-40. PubMed PMID: 9869918
  11. Rowiński WA, Wałaszewski JE. (1996) Organizational aspects of organ procurement. Ann Transplant. 1(4):61-4. PubMed PMID: 9869909
  12. Book: Homo Homini, Dzieje wybranych ośrodków transplantologicznych w Polsce, 2012, Publicat.
  13. poltransplant.org.pl

English:
The first successful cadaveric kidney transplantation in Poland was performed in Medical University in Warsaw on January 26th 1966 by professor Jan Nielubowicz and his team (Waldemar Olszewski, Jerzy Szczerbań i Wojciech Rowiński). The recipient 18 year-old nursing school student had been prepared and taken care afterwards by nephrologists Professor Tadeusz Orłowski and his team. The operation went well and the patient was discharged home 3 weeks after transplantation. The patient died 6 months later with well functioning graft due to acute pancreatitis (1, 2). Soon after Professor Wiktor Bross in Wrocław performed the first in Poland kidney transplantation from living related donor on March 31st 1966. At the time when the first cadaveric kidney transplantation was performed in Poland the World Registry organized by professor Joseph Murray recorded only 600 such procedures in the world. It was a great success of polish medicine. This was followed by some attempts in other centres which however were abandoned very soon and the program until eighties was continued in Warsaw only. The surgical team had been preparing to start the clinical transplantation program for over two preceding years in Surgical Research Laboratory headed by prof. Jan Nielubowicz. Prof. Wojciech Rowiński learned transplantation medicine as research fellow in Peter bent Brigham Hospital in Boston in 1965. 1967 laboratory In Warsaw Transplant Centre produced anti-dog, anti-rat, anti-human anti-lymphocytic sera (ALS) and purified globulins in horses, goats, pigs and rabbits. Evaluation of effect of administration of ALS on renal graft survival in dogs was preformed. The team one of the first in the world prepared rabbit-anti-thymocyte serum used in transplant patients (3, 4).
Up to 1976 some 80 cadaver (10-12 per year) and several living related donor kidney transplantations were performed. Since 1977 the number of kidney transplantations in Poland slowly increased to 40-46 per year (5, 6). The legal limitations were not helpful. Cadaveric kidneys procurement was considered as an element of post-mortem examinations. The diagnosis of brain death was well known but not legally permissible. Harvesting of the kidneys was done after cardiac arrest which resulted of high rate of ischemic injury of the organ. At early eighties revival of transplantation programs in other Medical School hospitals: Wrocław, Katowice, Gdańsk, Kraków, Szczecin was started. In Warsaw in addition to Department of Vascular Surgery and Transplantlogy (headed by prof. Nielubowicz, thereafter by prof. Jacek Szmidt) two other transplant centres were set up; Department of General and Transplantation Surgery (1983 headed by prof. Wojciech Rowiński) and Children’s Memorial Health Institute where the first cadaveric kidney transplantation was performed in 1984 by prof. Wojciech Kamiński and prof. Czesław Szymkiewicz. In 1985 the first kidney transplantation from living donor was done. The forth transplant centre in Warsaw was established in Hospital of Internal Affairs in 1990 headed by prof. Marek Durlik (7, 8).
Professor Tadeusz Orłowski created in 1975 the Transplantation Institute in Warsaw Medical University which consisted of two medical departments and department of experimental immunology with the tissue typing laboratory. The pretransplant assessment and the posttransplantation care including immunological monitoring were done in Institute. Both surgical transplant units closely cooperated with Institute. For several years Transplantation Institute was the leading transplant centre in Poland. In 1987 the new protocol originally developed in the Transplantation Institute showed that addition of promethazine to standard immunosuppression (befroe CsA era) resulted in better graft survival (9).
Regarding legal regulations of organ retrieval Transplant Act on Cells, Tissues and Organ Retrieval and Transplantation was issued by Parliament and signed by President in 1995. It was updated in 2005. The act approved presumed consent for organ retrieval, regulateed living donor organ donation, penalized commerce in organ transplantation. In 1993 National Transplantation Council was established by Ministry of Health, main tasks of this advisory body were to elaboration of strategy for development of tissue and organ transplantation, popularisation of the idea of organ donation and transplantation among general public, education of medical students and staff in organ donation and transplantation, active participation in creating legal regulations concerning organ and tissue transplantation. POLTRANSPLANT- Polish Organ Procurement and Sharing Organization was established in 1996 ( headed by prof. Janusz Wałaszewski), National Specialist in the Field of Clinical Transplantation (prof. Wojciech Rowiński) as executive body was appointed in 1996 (10, 11). In 1993 the Polish Transplantation Society was established, the first President was elected prof. Mieczysław Lao head of the Transplantation Institute in Warsaw.
In the early 80-ties kidney transplantation programs were started in a number of Medical School hospitals across the country.
In Wroclaw renewal of transplant program was started in 1983 by the surgeon prof. Klemens Skóra and nephrologist prof. Zenon Szewczyk. Since 1989 one hundred cadaveric kidney transplants were performed. In 1988 second transplant centre in Voivodship Hospital was created headed by prof. Wojciech Witkiewicz (12).
The first two kidney transplantations from living related donors in Upper Silesia region were performed in 1966 (September, November) by doctor Józef Gasiński in hospital in Bytom in cooperation with nephrologist prof. Zbylut Twardowski. Both recipients died due to sepsis after 28 and 136 days respectively. Renewal of transplant program was started in Department of General Surgery in Medical University in Katowice. In 1983 prof. Roman Kurzbauer performer 4 cadaveric kidney transplants, all of them failed due to infectious complications. Under new head of Department of General Surgery prof. Stanisława Kuśmierskiego with cooperation with Nephrology Department headed by prof. Franciszek Kokot in 1984-1990 more than 200 kidney transplantation were performed (12).
In Krakow 9 kidney transplantations (one from living donor) were performed by doctor Romuald Drop, first in march 1975. The responsible nephrologist was prof. Zygmunt Hanicki. In 1992 renewal of transplant program was reported by prof. Tadeusz Popiela and doctor Jerzy Bucki in cooperation with nephrologist prof. Władysław Sułowicz (12).
In Gdańsk the first kidney transplantation in Medical University was done on 31st August 1980 by prof. Wojciech Gacyk and prof. Jerzy Dybicki in cooperation with Department of Nephrology headed by Andrzej Manitius thereafter by prof. Bolesław Rutkowski (12).
In Szczecin the first kidney transplantation was performed in 1980 in II Department of Surgery in medical University by prof. Stansisław Zieliński. The second transplant centre in Szczecin was established in 1983 in Voivodship Hospital by doctor Marek Umiński, prof. Marek Ostrowski and doctor Janusz Lapis (12).
In the Białystok Medical University the first kidney transplantation was performed in 1989 by prof. Stanisław Głowiński with help of prof Jacek Szmidt from Warsaw in cooperation with Department of Nephrology headed by prof. Michał Myśliwiec (12).
In Poznan in Medical University the first kidney transplantation was performed in 1985 in Department of General Surgery and Gastroenterology by prof. Adam Deja in cooperation with prof. Maciej Krzymański and prof. Andrzej Oko from the Department of Nephrology. The second transplant centre was created in Poznań in 1994 in Voivodship Hospital by prof. Zbigniew Włodarczyk, Konstanty Tukałło, Adam Deja and Maciej Głyda (12).
In Łódź two transplant centres started their activity in 1996, first inthe Medical University in Department of Surgery heade by prof. Janusz Wasiak and prof. Janusz Strzelczyk in cooperation with prof. Witold Chrzanowski from Department of Nephrology, second in Pirogow Voivodship Hospital headed by prof. Józef Matych (12).
In Lublin transplant program was started in 1994 inthe Medical University by prof. M.Jesipowicz, prof. S.Stettner, and prof. S.Rudzki in cooperation with prof. Andrzej Książek, head of the Department of Nephrology (12).
In Bydgoszcz prof. Zbigniew Włodarczyk created new transplant centre in 2000 year.
The youngest transplant centre was established in Olsztyn in 2010 by prof. Wojciech Rowiński and doctor Andrzej Kobryń (12).
During the 51 years since first renal transplantation until December 31st 2016 the total number of 22,658 kidney from deceased donor and 766 kidney from living donor transplantations were performed in Poland. Currently there are 21 kidney transplant centres performing 1000 transplants per year in Poland (13).

References:

  1. Orlowski T, Nielubowicz J, Gradowska L, Rowiński W, Klopotowska E. (1966) Function of a transplanted kidney. Pol Arch Med Wewn. 37(1):47-54. Polish. PubMed PMID: 5330481
  2. Nielubowicz J, Orlowski T, Rowiński W, Szczerbań J, Szostek M, Kamiński B, Olszewski W, Ladygin J, Lao M, Gradowska L. (1966) Transplantation of kidney from cadaver. Pol Przegl Chir. 38(10):1030-4. Polish. PubMed PMID: 5341716
  3. Rowiński W, Szmidt J, Rosnowska M, Baraniewski H, Grupińska E, Tupalska B, Brühl A, Krawczyński K, Madaliński K, Nowoslawski A. (1970) Effect of long-term administration of horse antilymphocyte serum to healthy dogs. Pol Arch Med Wewn. 45(2):281-9. Polish. PubMed PMID: 5471505
  4. Rowiński W, Szmidt J, Brühl A, Dziedziul S, Tupalska B, Baraniewski H, Grupińska E, Opertowski A, Nielubowicz J. (1970) Production and titration of antilymphocyte serum for use in dogs. Pol Arch Med Wewn. 45(2):275-80. Polish. PubMed PMID: 4919365
  5. Nielubowicz J, Orlowski T, Wesolowski S, Falda Z, Gradowska L, Rowińska D, Rowiński W, Skośkiewicz M, Szostek M, Filipowicz Z, Glyda J, Goliszek Z, Jedrzejewski R, Kardasiewicz W, Klepacka J, Klopotowska E, Kossowska B, Koziak H, Krzywicka E, Lao M, Ladygin J, Marzinek B, Miller J, Michalowicz B, Machowski Z, Olszewski K. (1970) Results of kidney transplantation in the Warsaw center. Pol Arch Med Wewn. 45(2):175-8. Polish. PubMed PMID: 4919357
  6. Rowiński W. (1970) Results of kidney transplantation in Poland. Pol Arch Med Wewn. 45(2):267-73. Polish. PubMed PMID: 4919364
  7. Rowiński W. (1996) History of organ transplantation in Warsaw. A personal perspective. Ann Transplant. 1(1):5-8. PubMed PMID: 9869929
  8. Lao M, Gradowska L, Stryjecka-Rowińska D, Szmidt J, Rowiński W, Wałaszewski J. (1997) Kidney transplantation in Warsaw and Poland in the years 1966-1996. Pol Arch Med Wewn. 98(10):294-303. Polish. PubMed PMID: 9557082
  9. Orłowski T, Gaciong Z, Paczek L. Promethazine.(1987) results of triple-drug immunosuppression for kidney transplantation. Transplant Proc. 1987 Feb;19(1 Pt 3):2124-5. PubMed PMID: 3079074
  10. Rowiński W, Lao M, Wałaszewski J, Lisik W. (1996) Social, legal and medical limitations of organ transplantation in Poland. Ann Transplant. 1(3):36-40. PubMed PMID: 9869918
  11. Rowiński WA, Wałaszewski JE. (1996) Organizational aspects of organ procurement. Ann Transplant. 1(4):61-4. PubMed PMID: 9869909
  12. Book: Homo Homini, Dzieje wybranych ośrodków transplantologicznych w Polsce, 2012, Publicat.
  13. poltransplant.org.pl
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History of the Polish Society of Nephrology

Abstract

Polish Society of Nephrology (PSN) was born during the Founding Congress organized in September 1983 in Bydgoszcz. The main propagator of this idea was prof. Franciszek Kokot (Katowice) – widely recognized in whole nephrological community. In Bydgoszcz the PSN by-laws was approved and first Executive Council of the Society was elected. First PSN president was elected Tadeusz Orłowski (Warszawa) and vicepresident Andrzej Manitius (Gdańsk) respectively. Subsequent Congresses were organizes each three years in following cities: Kraków (1986), Gdańsk (1989), Katowice (1992), Lublin (1995), Poznań (1998), Kraków (2001), Białystok (2004), Wisła (2007), Bydgoszcz (2010), Wrocław (2013) and Łódź (2016). During these meetings and annual conferences organized between congresses actual topics dedicated to pathophysiology, clinical nephrology, dialysis therapy and kidney transplantation were presented and discussed. Prof. Tadeusz Orłowski was the PSN president till 1986 and subsequently other known Polish nephrology leaders hold this function: Kazimierz Bączyk (Poznań: 1986-1989), Franciszek Kokot (Katowice: 1989-1998), Bolesław Rutkowski (Gdańsk: 1998-2004), Michał Myśliwiec (Białystok: 2004-2007), Andrzej Więcek (Katowice: 2007-2010), Jacek Manitius (Bydgoszcz: 2010-2013), Magdalena Durlik (Warszawa: 2013-2016) and Michał Nowicki (Łódź: 2016 – present). Number of PSN members has risen from 150 at the beginning to over 1000 nowadays. During this 34 years regional structure of PSN was established and today 9 regional divisions are actively working. In 2014 Young Nephrologists’ Club was organized in PSN which is collaborating with Young Nephrologists’ Platform existing in the ERA-EDTA structure. PSN is collaborating closely with international (ISN, ERA-EDTA, IAHN) and Polish (Polish Transplantation Society) scientific societies. Many well known scientists from whole the world were recognized as Honorary Members of PSN. Coming to the end of this short presentation of the PSN activity it is worth to mention also that two journals are officially recognized by our society: Nefrologia I Dializoterapia Polska (Polish Nephrology and Dialysis Therapy) edited from 1997 in Kraków and Forum Nefrologiczne (Nephrological Forum) edited from 2004 in Gdańsk.

Keywords: Poland, nephrology, society, history

Introduction

Polish Society of Nephrology (PSN) was founded during its First Founding Congress organized in September 1983 in Bydgoszcz. At this time two structures connected with nephrology existed in Poland: Nephrological Committee of the Polish Academy of Science chaired by prof. Tadeusz Orłowski (Warsaw) and Nephrological Section of the Polish Society of Internal Medicine chaired by prof. Kazimierz Trznadel (Łódź). The main initiator and propagator of the PSN was prof. Franciszek Kokot (Katowice) who was then member of the European Dialysis and Transplant Association Board (1, 2). One has to remember that it was time when other National Nephrological Societies were founded in whole Europe. Prof. Kokot was supported strongly by the group of other known Polish nephrologists like prof. Kazimierz Bączyk (Poznań), prof. Zenon Szewczyk (Wrocław) and prof. Zygmunt Hanicki (Kraków) and great part of the younger colleagues. All of them worked hard to persuade this idea to other nephrological leaders. In Bydgoszcz last official Conference of the Nephrological Section of Polish Society of Internal Medicine was transformed to the PSN Founding Congress. It is necessary to mention that local organizer of this event was prof. Edmund Nartowicz, Head of Nephrology Department in Bydgoszcz and all necessary documents were prepared by prof. Kazimierz Trznadel (Head of Nephrology Department in Military Hospital in Łódź). During this Founding Congress rules and regulations of the new Society were established and first Executive Council was elected. First PSN president for three years term prof. Tadeusz Orłowski (Figure 1) prominent nephrologist form Warsaw was elected and Vicepresident prof. Andrzej Manitius – Head of Nephrology Department in Gdańsk Medical University (3, 4). Prof. Tadeusz Orłowski was the PSN president till 1986 and subsequently other known Polish nephrology leaders hold this function. Prof. Kazimierz Bączyk from Poznań (Figure 2) was the second and prof. Franciszek Kokot from Katowice (Figure 3) the third PSN president. Whole list of PSN presidents and period of their activity on this position was presented in Table 1, Figure 4, Figure 5 and Figure 6. Subsequent Congresses were organized every three years in following cities: Kraków (1986), Gdańsk (1989), Katowice (1992), Lublin (1995), Poznań (1998), Kraków (2001), Białystok (2004), Wisła (2007), Bydgoszcz (2010), Wrocław (2013) and Łódź (2016). There were also annual scientific and educational conferences organized under the auspices of PSN like:

  1. “Advances in peritoneal dialysis” organized from 1996 in different nephrological centers – prof. B. Rutkowski and currently prof. M. Lichodziejewska-Niemierko (Gdańsk).
  2. “Advances in Nephrology and Hypertension” Polish-German-Czech conferences organized from 1994 by turns in Poland (mainly in Wisła – prof. F. Kokot and Wrocław – prof. M. Klinger), Germany (mainly Gorlitz) and Czech Republic (mainly Liberec).
  3. Post ASN Meetings – Gdańsk Repetitory in Nephrology organized from 2002 by prof. B. Rutkowski
  4. Katowice Seminar – Advances in Nephrology and Hypertension organized from 2001 by prof. A. Więcek
  5. Top Nephrological Trends organized in Poznań currently by prof. A. Oko, earlier from 2002 as Great Poland Spring Nephrological Actualities by prof. S. Czekalski
  6. Nephrocardiology – conference organized from 2005 in Białowieża by prof. M. Myśliwiec (Białystok) and currently by his successor prof. B. Naumnik (Białystok)
  7. Płock Nephrology Days organized between 1995 and 2005 by dr M. Świtalski in Płock
  8. Cracovian Dialysis Days – very special meeting organized on the biennial mode from 1994 until 2014 this meetings which is uniting all parties involved in dialysis – physicians, nurses, technicians, dietitians and patients was organized by prof. O. Smoleński. After his sudden death in 2015 this important meeting is organized by his successors dr A. Smoleńska, mgr M. Liber and prof. J. Pietrzyk.
  9. Nephrological Conference in Włocławek organized from 1992 by doc. J. Ostrowski.

It is worth to mention that also Regional PSN divisions are organizing educational conferences at least 2–3 times during a year. Lectures during all these events were delivered not only by Polish speakers but also very often by eminent nephrologists from Europe and United States. It is worth to mention that many well-known scientists from whole the world were recognized as Honorary Members of PSN. Whole list of foreign PSN Honorary Members is shown in Table 2. One may recognize that among them are also active IAHN members like: G. Richet, S. Massry, G. Eknoyan, R. Ardaillou, A. Heidland and M. Mydlik. There are also twenty six eminent Polish nephrologists who were recognized as PSN Honorary Members (Table 3). Number of PSN members has risen from 150 at the beginning to over 1000 nowadays (Figure 6). During this 34 years regional structure of PSN was established and today 9 regional divisions are actively working. There are also several sections in the PSN central structure eg. historical, rehabilitation in chronic kidney disease, Polish Renal Registry and Polish Registry of Kidney Biopsy. In 2014 Young Nephrologists’ Club was organized in PSN which is collaborating with Young Nephrologists’ Platform existing in the ERA-EDTA structure. PSN is collaborating closely with international (ISN, ERA-EDTA, IAHN) and Polish (Polish Transplantation Society) scientific societies. It is worth to mention that Polish nephrologists played active role in these organizations. Prof. J. Roguski (Poznań) and prof. Stefan Angielski were members of the ISN Board in sixties and seventies. Later on prof. F. Kokot was a member of Nominating Committee and prof. A. Więcek – Head of the section organizing COMGAN CME courses and prof. B. Rutkowski member of the Historical Committee. Even closer is collaboration with ERA-EDTA where several Polish representatives were elected as members of the Council like: prof. T. Orłowski, prof. F. Kokot (3 times), prof. A. Więcek, prof. M. Klinger, prof. J. Małyszko. One have to remember that prof. A. Więcek after accomplishing his second term as Council member was elected as a Secretary-Treasurer and later hold most important position of ERA-EDTA President during last three years (2014-2017). Additionally prof. B. Rutkowski was a member of the Scientific Board of ERA-EDTA Registry and prof. R. Gellert director of the Registry Office. It is worth to mention that three Polish nephrologists were among founders of the International Society of Peritoneal Dialysis: prof. K. Bączyk (Poznań), prof. Z. Twardowski (Lublin), prof. P. Hirszel (Kraków) (4). Currently prof. M. Lichodziejewska-Niemierko is member of the Council in this Society. Very successful EuroPD Meeting was organised in 2015 in Kraków coordinated by prof. W. Sułowicz (Kraków) and prof. Lichodziejewska-Niemierko (Gdańsk). Another scientific collaboration was maintained between PSN and International Society of Uremic Research and Toxicity (ISURT). B. Rutkowski was member of the Council, president elect, president and past president in this Society. He organized also very successful ISURT Congress in Sopot in 2007. Special attention has to be paid to collaboration with the International Association for the History of Nephrology (IAHN). Prof. B. Rutkowski spent in the IAHN Council four terms as member, president elect, president and past president of the Association. Doc. Janusz Ostrowski from Włocławek was Council member, president elect and currently he is holding position of IAHN president. Dr Marek Muszytowski from Toruń was Council member and currently is secretary treasurer. Three IAHN Congresses were organized in Poland: in 2004 in Gdańsk in 2010 in Toruń and in 2016 in Wieniec near Włocławek. All these events were organized in collaboration with PSN.

Coming to the end of this short presentation of the PSN activity it is worth to mention also that two journals are officially recognized by our society: Nefrologia i Dializoterapia Polska (Polish Nephrology and Dialysis Therapy) edited from 1997 in Kraków (Chief editor – prof. W. Sułowicz) and Forum Nefrologiczne (Nephrological Forum) edited from 2004 in Gdańsk (Chief editor – prof. B. Rutkowski).

In summary we like to underline that during almost 35 years of PSN activity our Society help to establish high position of Polish nephrology among European countries both from scientific and practical point of view (5). This fact is the result of hard work of many people mentioned in this article and many other anonymous PSN members. We do hope that young generations of Polish nephrologists will keep this high level and also will remember about their mentors who established and developed PSN.

 

References:

  1. Rutkowski B.: Professor Franciszek Kokot – his contribution in the development of Polish nephrology: Pol Arch Med Wewn 1994, 9: 1 11-13.
  2. Rutkowski B.: Leader and promotor of the of the polish nephrology. In: Franciszek Kokot, Ed. Medical University of Silesia, Main Library, Katowice 1999.
  3. Heidland A., Pączek L. Professor Tadeusz Orłowski – in memory of a pioneer in European Nephrology and Transplantation. Kidney Blood Press. Res. 2009; 32: 304-306.
  4. Ostrowski J., Rutkowski B.: Honorary member of the Polish Society of Nephrology. Part One: Tadeusz Orłowski. Forum Nefrol. 2013; 1: 71-75.
  5. Czekalski S. Kazimierz Bączyk, Poznań, Poland. Nephrol. Dial. Transplant. 1996; 11:1656.
  6. Czekalski S., Rutkowski B. The History of nephrology in Poland. J. Nephrol. 2006; 19 (supl. 10): S150-S158.
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Nils Alwall and his input into the development of Polish haemodialysis

Abstract

Nils Alwall’s fame and reputation as a pioneer and leader of haemodialysis treatment of patients with chronic renal disease was widespread across Europe in the 1940s, 50s and 60s. Little wonder, then, that his renowned clinic in Lund, Sweden was willingly visited by many doctors from Central-Eastern Europe including those from Poland. The first Poles to meet Alwall in his native Sweden right after WW2 were Maria (nurse) and Bożysław (technical worker) Kurowski. The meeting gave rise to the publication of the first nursing paper in Poland in 1958. Nils Alwall’s archive in Lund holds rich correspondence exchanged with Polish doctors. The first one to establish contacts with the famous Swede was dr. Zygmunt Hanicki from Krakow, who later received one of Alwall’s first dialysis machines enabling him to perform experiments whose results were published in 1949 and 1950. The first longer stay in Lund started in 1957 when dr. Tadeusz Orłowski, the future leader of the Polish nephrology and transplant therapy, made his way to the famous centre. Next, in 1958 the clinic was visited by dr. Zdzisław Wiktor of Wrocław, the future Head of one of the first clinics of nephrology in Europe and the following year dr. Jan Roguski of Poznań also sought to gain experience there. In the meantime, a number of dialysis centres equipped with Alwall-type haemodialysis machines were set up in Poland including the Poznań unit (1958) established by Kazimierz Bączyk, the Warsaw one (1959) by Tadeusz Orłowski and the Krakow centre (1962) by Zygmunt Hanicki. It was in 1960 when dr. Zbigniew Fałda from Warsaw completed his training in Lund. Later, in 1966 the Lund centre hosted dr. Jan Kurkus. Nils Alwall’s first visit to Poland was in 1959 during the Congress of the Polish Society of Internal Medicine in Gdańsk. His second visit to Poland happened in 1970 when he gave two lectures. By the time Nils Alwall retired as many as a few dozen Polish doctors had gained experience in Lund later transplanting it to their centres in Poland confirming the significant impact of the Lund centre on the development of the Polish dialysis therapy.

Keywords: Nils Alwall, dialysis unit, Lund University, history of haemodialysis, Poland

Introduction:

There can be little doubt that the introduction of haemodialysis into the treatment of patients with chronic renal disease was among the greatest medical achievements of the 20th century. In Europe, the pioneering investigations into the method began in the 1940s and were conducted independently by two outstanding figures – the Dutch Willem Kolff and the Swede Nils Alwall. Apparently, Poland was one of the first countries in post-war Europe which could have tapped into the advantages of the new method when one of the clinics of the Krakow Medical University received an early haemodialysis machine designed by Kolff, had it not been for the fact that most probably it was never used to treat patients. Alas, with Kolff’s interest being shifted to developing other artificial organs his cooperation with Polish doctors stopped. The other pioneer of the European dialysis treatment was Nils Alwall of Lund University in southern Sweden. It was him who in the 1940s, 1950s and 1960s had by far the largest experience in applying haemodialysis to treat patients with renal insufficiency using a self-designed machine. The first devices to be used in Poland, starting from 1958, came from Sweden and Alwall’s centre in Lund was the place where Polish doctors became acquainted with and gained experience in using this particular method of treatment (1- 3).

The history of Alwall’s contacts with Poles began right after the war when the Poznań-educated lawyer Bożysław Kurowski and his nurse wife Maria, both prisoners of German concentration camps, settled down in Sweden. The Polish couple worked at Alwall’s clinic since the early days of the newly-established dialysis centre. B. Kurowski’s job was as a technical assistant at the centre while his wife worked as a scientific assistant at the science and research laboratory. As such, both gained profound knowledge of the issues related to dialysis treatment. B. Kurowski was a co-author of a compendium titled Dialysis – the Tasks of Technical Assistants giving a detailed description of a machine preparation and testing as well as all the other activities necessary to run a dialysis session. As it was, Kurowski was Alwall’s right-hand man when it came to operating artificial kidneys. His wife, Maria, was the author of Artificial Kidney Saves Lives, a paper published in Pielęgniarka Polska in 1959 as one of the first publications on the subject in Poland. Owing to their linguistic skills, the Kurowskis were frequently asked by Alwall to introduce overseas visitors into technical intricacies of dialysis and their home would always be full of foreign guests including those from Poland who were having a training at Alwall’s clinic (4) (Figure 1).

The first letter from Poland to Alwall was sent on 12th March 1948 by dr. Zygmunt Hanicki from the 2nd Department of Internal Medicine at the Jagiellonian University in Krakow headed by professor Tadeusz Tempka. In his correspondence Hanicki enquired about technical details and the price of a dialysis machine. At the time, the new invention cost approx. 500-600 Swedish crowns, yet its production was a significantly long process. In order to go around this setback, Alwall’s idea was to lend an older-type machine, which had been used for performing dialysis in dogs, with which Hanicki could start experimenting. The size of the machine made it impossible to use it for human treatment. The organisational activities were troublesome and involved the Polish consulate in Stockholm, yet, finally, the machine arrived in Krakow in November 1948. The rich follow-up correspondence between Hanicki and Alwall, first in English and then in German, referred to the problems of starting the machine, dialysis clinical details or availability of heparin. The analysis of the letters exchanged by the two reveals that heparin was delivered to Krakow in December 1948, however, it remains unknown whether it was used for further experimental work with Alwall’s machine or not. In his early experiments, following in the footsteps of the famous Swede, Hanicki used sodium citrate as an anticoagulant. The letters unveil that Hanicki’s visit to Lund was also considered and discussed, however, it never happened. Instead, on 27th June 1949 he sent to Lund his first Polish publication on the work and application of the artificial kidney. In his subsequent publication, out in 1950, Hanicki presents the results of experimental dialyses with the use of aqueous urea solution and uremic patients’ blood. In July 1951 another piece of information about a planned visit to Lund appeared when Alwall issued a formal invitation for Hanicki to spend 6 weeks in his centre. Again, the visit never happened. In 1956, Hanicki informed Alwall about the fact that the Health Ministry had purchased three artificial kidneys from Avesta company which were to be delivered to the cities of Poznań, Warsaw and Krakow. It was the first information concerning the planned purchase of an artificial kidney for Krakow. We know that Andrzej Biernacki and Jan Roguski made significant efforts to ensure delivery of dialysis machines for Poznan and Warsaw respectively, which happened in 1958. Two years earlier, in February 1956, Hanicki made his way to Prague, Czechoslovakia to be trained with a machine that had already been installed there. In his last letter dated 29th January 1964 Hanicki reported that at the time there were as many as 5 artificial kidney centres, 3 of which used Avesta machines. Moreover, he informed that the Krakow centre had already been operating for one year and a half. Historical records show that it was opened in 1962 when the Warsaw and Poznań ones had already been in use. Later, Zygmunt Hanicki became Head of Clinic of Nephrology in Krakow. The correspondence between Alwall and Hanicki is among the most voluminous in the archive containing no fewer than 30 letters (5 – 8) (Figure 2).

Professor Stefan Wesołowski, a Warsaw-based urologist, met Alwall during a medical congress in Athens in April 1955. Two months later he sent a letter to Sweden asking Alwall if Wesołowski’s assistant, Tadeusz Krzeski, could pay a visit in Lund in order to learn about the artificial kidney. The answer was obviously positive and between 20th and 30th November 1956 Krzeski had a chance to get hands-on experience with the artificial kidney in Lund. It was the first documented visit of a Polish doctor at Alwall’s clinic. We know that later Krzeski remained faithful to his department of urology, Wesołowski, however, took part in Poland’s first peritoneal dialysis session performed in 1953 by Orłowski and Nielubowicz.

Tadeusz Orłowski, a Warsaw Medical University professor-to-be, met Nils Alwall in Geneva in October 1956, and then, in July 1957, sent a letter to Lund asking about a possibility to have a 2-month training there. The request was supported by a letter of recommendation provided by Andrzej Biernacki, the Head of the 1st Clinic of Internal Medicine in Warsaw. The visit, which was the first longer-time training of a Polish doctor in Lund, took place between 28th October and late December 1957. On his return to Poland, Orłowski shared the new knowledge and experience with his Polish colleagues at the clinic. Besides invaluable knowledge he also brought back new designs of catheters and of other necessary equipment, the value of which could not have been exaggerated for the clinic getting ready to obtain the first artificial kidney purchased by the Ministry of Health in mid-1958. The machine was first put to use to perform the first test dialysis in a dog on 31st December 1958. The first dialysis in a human patient happened only 2 days later, on 2nd January 1959 when a child was treated with the new method. A detailed account of the preparation process and the use of Alwall’s artificial kidney can be found in Zbigniew Fałda’s article. In subsequent years, Tadeusz Orłowski left the dialysis department to his assistants himself taking up the organisation of the renal transplant programme (9- 11) (Figure 3).

In his letter to Alwall dated 8th July 1958, professor Zdzisław Wiktor form the Wrocław Clinic of Nephrology asked the famous Swede about a possibility to have a training in Lund, which started on 10th December and lasted 2 weeks. The Clinic’s Guest Book contains an entry in German from 29th December 1958. In the next letter, Wiktor invited Alwall to come to Wrocław following the 20th Congress of Internal Medicine to be held in Gdańsk on 10-12 September 1959 which Alwall was going to attend. Alas, Alwall having to return to Lund, the visit never happened. Zdzisław Wiktor was the Head of Poland’s first and Europe’s one of the first clinics of nephrology established in 1958. The first haemodialysis in his centre was performed in 1964 (12, 13).

Jan Roguski from the 2nd Clinic of Internal Medicine at the Medical University of Poznań met Alwall during the Congress of Urology in Genoa in October 1956. In his letter dated 15th June 1957 he informed Alwall that the Ministry of Health had decided to purchase an artificial kidney from Sweden for the Poznań centre and asked the Swede to try and hasten the production and delivery of the machine. Alwall did intervene and promised that it would be made available within a few months, at the same time inviting one of the Poznań clinic’s doctors to Lund with an aim to provide training about the operation of the artificial kidney. Although dr. Kazimierz Bączyk was the one selected to visit Lund the lack of funds from the Ministry of Health made the trip impossible. Fortunately, Bączyk, who had already participated in a short training in Bern, Switzerland, possessed some knowledge and experience in using Alwall’s device. The artificial kidney, along with a batch of cellophane membrane, arrived in Poznań in mid-1958 and was first used in autumn that same year. The first haemodialysis session in Poland was performed in November 1958 by a team headed by Kazimierz Bączyk. Later, due to delayed deliveries from the USA, Roguski asks Alwall for help in obtaining cellophane membrane, a request which is eagerly granted. In January 1959 Roguski writes a letter in which he asks for an invitation to Lund for April in order to learn about the system of work at the clinic. However, the arrangement of the precise term of the visit will prove problematic due to Roguski’s planned trip to Philadelphia, USA in connection with Rockefeller Foundation Scholarship. Eventually, when he makes it to Lund on 2nd April 1959, Alwall is away giving lectures in Germany, Switzerland and Greece, so the two do not have a chance to meet. The first occasion to talk comes a few months later during the 20th Congress of Polish Internists held in Gdańsk on 10-12 September 1959 to which Alwall was officially invited by Roguski (14- 16).

One of the subjects discussed during the Congress was the treatment of advanced uraemia with the use of the artificial kidney, the method which had been used in Poland for the past 2 years. Alwall took an active part in the symposium talking especially about indications for dialysis and treatment results. With a whopping number of over 1000 sessions performed since 1946, the Lund clinic had enormous experience in the matter. Within the two preceding years (1957-1958) as many as 200 sessions were performed annually, which made it the leading haemodialysis centre in the world. The results of his observations were published by Alwall in the Polish Internal Medicine Archive in 1960 (17, 18).

In October 1959 Alwall received a letter from professor Antoni Horst which contained an invitation for Roguski’s 60th birthday and his 35th anniversary of scientific activity. The celebration was to be held in autumn 1960 and Alwall was requested to give a speech of his choice that would later be published in Polish Medical Journal. Finally, in 1960, the famous Swede prepared and published in Polish Doctors’ Weekly his paper titled On the Size of Kidneys in Acute Renal Failure (19) (Figure 4).

It was during the Congress of Internal Medicine in Gdańsk in September 1959 and, then, during his visit to the 1st Clinic of Internal Medicine in Warsaw that Alwall met Andrzej Biernacki and the clinic assistant Zbigniew Fałda who showed him around the Artificial Kidney Department. In his letter dated 10 February 1960 Fałda asked about a possibility to work at the Lund Dialysis Department for one month some time between May and August 1960. These being holiday months in Sweden when the clinic is usually short of staff and Alwall knowing about the Warsaw unit’s experience where 60 dialysis sessions had already been performed in patients combined with Fałda’s publications on technical problems with extracorporeal dialysis and his involvement in the creation of the film titled The Treatment of Acute Renal Failure with Alwall’s Artificial Kidney, permission was granted. Consequently, Fałda arrived in Lund on 31st May 1960 with disposable PVC venous catheters produced in cooperation with engineer Juliusz Deczkowski used in Warsaw since the late 1959. The catheters were put to test during dialysis sessions in Lund. Although Alwall himself was not present during the catheter implementation, later his comment was: “it works” and “it’s a good idea”. At that time glass cannulas and glass silicone-covered air-vents were used, little wonder, then, that Alwall was interested in replacing them with Fałda’s plastic catheters. On his return to Warsaw, Fałda sent to Lund about 100 catheters for further tests. Back in Sweden a young girl treated for 6 months with an initial diagnosis of acute renal failure caught Fałda’s attention. Anuria was still present, yet the general condition of the patient was good despite the unsolved problem with vascular access, which suggested remarkable skills of the dialysis team. Most probably, the acute renal failure had turned into the chronic one. Belding Scribner from Seattle, USA, started treating chronic renal failure a few months later (March 1960) using a new type of vascular access known as the Scribner’s shunt. However, amounting to 100 USD the cost of this facility was significant, which made it hardly affordable in Poland. Having returned from Lund Fałda had a similar idea and, in July 1960, he started working with Deczkowski with the aim to develop a Polish arteriovenous shunt based on widely-available polyethylene. Their shunt, which was later subject to gradual improvement, was successfully used at the Warsaw clinic to facilitate the process of treatment of acute renal failure. It was in August 1963 when Fałda gave a few arteriovenous shunts of his design to Alwall. Although he had already used Quinton shunts for the treatment of 15 patients he reportedly intended to use Fałda’s development at his clinic. That said, no clinical opinion was ever offered or published. Dr. Fałda’s impressions from his 1960 stay at the Lund clinic can be found in his two papers published in 1960 and 2010. The 1960s was a decade when more Polish doctors established contacts with Alwall and visited Lund and more papers on his artificial kidney were published (20- 23) (Figure 5, Figure 6).

Dr. Jerzy Wroński from the Miners Hospital in Bytom, Poland visited Nils Alwall in January 1962 after the hospital had put forward plans to open a dialysis unit. Wroński went to Sweden in order to learn about the technical details concerning the installation and operation of a dialysis machine, water quality as well as the general arrangement of dialysis facilities. Alwall’s response to these doubts was that a laboratory room should be arranged in a way that would enable transforming it into a dialysis room in the future, the size of which in turn should make it possible to fit in a ventilator. As regards water quality, it must be softened by means of special filters. The Bytom dialysis centre was opened in 1964, following efforts made by its organiser – Zbylut Twardowski, the future world-class nephrologist, author of numerous treatment-facilitating solutions for both HD and PD.

Jan Kurkus, the former assistant at the 1st Clinic of Internal Medicine in Warsaw, visited Alwall’s centre in September 1966 with a letter of recommendation from Tadeusz Orłowski, the Head of the Warsaw clinic, in his hand. The Swedish staff were more than kind and helpful towards the young Pole. During a two-hour conversation at Alwall’s office Kurkus had a chance to learn about the intricacies of the artificial kidney and was shown posters presenting growing trends of the numbers of patients in need of dialysis treatment in the years to come. The analysis of death certificates indicated that as many as 70 new patients per one million would appear each year, the level which was achieved in Sweden in the mid-1990s. It was during his stay in Lund that Jan Kurkus visited the Kurowskis for the first time, the acquaintance which was to change into a deep friendship with frequent almost family-like meetings. Kurkus’ second visit to Lund happened in 1969 following the ISN Congress in Stockholm when, accompanied by other workers form the 1st Clinic of Internal Medicine from Warsaw, he visited the newly-built Department of Nephrology and the Dialysis Centre with which, almost 26 years later, he was to be professionally tied.

The 1969 ISN Congress in Stockholm was preceded by Fałda’s request to Alwall concerning the participation of a group of doctors from Warsaw in the event and their intention to visit the Lund clinic afterwards. The visit of the group (Zbigniew Fałda, Hanna Fałda, Liliana Gradowska, Włodzimierz Kardasiewicz, Jan Kurkus, Mieczysław Lao, Wojciech Rowiński, Danuta Rowińska, Jadwiga Wojtulewicz-Kurkus) took place on 19th June 1969. Indeed the two decades between 1950 and 1970 saw dozens of Polish doctors visit Alwall and his clinic each year.

In June 1970 Tadeusz Orłowski invited Nils Alwall to Warsaw to give a series of lectures. The plane from Brussels with Alwall on board landed at Warsaw airport in 25th October 1970. During his stay the famous researcher gave two lectures: A Long-Term (19 years) Clinical Observation of 32 Living Patients with Acute Glomerulonephritis with Oliguria Subjected to Dialysis Treatment in 1947-1969 and Dialysis Treatment and its Problems in Sweden. All through his stay (25-28 October) Alwall was ushered in Warsaw by Zbigniew Fałda. Today, we have a pleasure to see the agenda of Alwall’s visit in the Polish capital which included dinner at the Jabłonna palace and an evening at the opera.

Zbigniew Fałda’s future professional path has led him from the Warsaw dialysis centre, which he headed, through a clinic in Seattle, USA, where he did a one-year-long apprenticeship, to the position of the Head of the Department of Nephrology and the Dialysis Centre in Bad Wildungen, Germany.

Although Nils Alwall retired in June 1971 at the age of 67 for a few following years he still held his “pensioner’s room” at the clinic. His successor as the Head of the centre was Tore Lindholm, who managed it until he retired in 1989, at which time, a Pole Jan Kurkus took over and continued until 2006.

The Polish-Swedish cooperation, which started in the 1940s, flourished throughout the next decades. It has brought the Polish dialysis treatment numerous benefits and was crowned in 1989 when J. Kurkus took Alwall’s position paying back the Polish debt to Nils Alwall and his clinic (24).

The general interest in the Clinic, especially in the development of dialysis treatment in Lund, when it was headed by Alwall’s successors was still significant, though the number of visitors was gradually decreasing. This state of affairs was largely down to the remarkable development of dialysis treatment, the appearance of new centres of nephrology and easy access to dialysis-related equipment. The Lund clinic has always been open to accept doctors and other medical personnel from Poland, both during and after Alwall’s management. Its guest book contains entries from most of the visitors including individuals who later played the main roles in the development of dialysis treatment, notably haemodialysis, in Poland, headed university clinics, departments of nephrology and regional dialysis units, toxicology and transplant centres. The list of renowned names includes: Witold Zegarski, Wojciech Witkiewicz, Teresa Wyszyńska, Kazimierz Trznadel, Zofia Wańkowicz, Andrzej Manitius, Stanisław Czekalski, Rafał Wnuk, Antoni Sydor, Olgierd Smoleński, Adam Jelonek, Ryszard Gellert, Bolesław Rutkowski, Andrzej Książek, Janusz Puka, Joanna Matuszkiewicz-Rowińska, Anna Skrzycka, Zbigniewa Śledziński, Wojciech Pruszczyński, Leszek Sadowski, Mirosław Kroczak, Marlena Ruszkiewicz, Marek Stopiński, Janusz Sadowski, Krystyna Szprynger. A very special kind of cooperation was established between the Lund centre and the Department of Nephrology and Dialysis Treatment at the Voivodship Hospital in Włocławek, Poland headed by Janusz Ostrowski. The cooperation was based on mutual week-long visits at the respective departments by doctors, nurses and technical personnel once a year in 1999-2006, the benefits of which on both sides were evident, and the list of those willing to participate in the exchange was never short.

Conclusion:

It was the primary intention of the author to highlight the considerable influence of the Swedish professor Nils Alwall and his dialysis centre on the development of Polish dialysis treatment. The great number of Polish doctors who have visited the world’s leading haemodialysis centre in Sweden in pursue of knowledge, experience and self-development must have had a positive impact on the development of the field in their home country bringing it to the present state of being on par with the best in the world.

The author wishes to thank professor Jan Kurkus for his invaluable remarks and help in preparing the paper.

 

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Pioneer Women in Pediatric Nephrology in Poland

Abstract

There were three prominent female pioneers of pediatric nephrology in Poland, professors Teresa Wyszyńska, Maria Sieniawska and Marta Uszycka-Karcz. All three started their activity in late 50-ties and step-by- step developed nephrology service for children in Warsaw and Gdańsk. Thanks to their personal activity and efforts, the pediatric nephrology became a modern subspecialty, using evidence-based guidelines, conducting scientific research and providing renal replacement therapy to all children in Poland. All three ladies were leading persons in this field for many years and their impact on development of this medical specialty remains to be fundamental and unquestionable.

Key words: pediatric nephrology, Teresa Wyszyńska, Maria Sieniawska, Marta Uszycka-Karcz, Poland

The Women in Nephrology (WIN) initiative was founded in 1983 by women in the field of nephrology. The purpose was to develop the mentors to women in the field. Over the years, the primary purpose was extended to mentoring both professional men and women in the field of nephrology, and currently WIN provides access to senior women in the field of nephrology who are motivated to mentor junior doctors (1). Interestingly, the pioneer history of pediatric nephrology in Poland resembles the overall idea of WIN initiative, as three prominent persons who created and developed this subspecialty, starting from 60-ties of the 20th century. They were Teresa Wyszyńska, Maria Sieniawska and Marta Uszycka-Karcz.

Teresa Wyszyńska was born in Warsaw (Figure 1). She was graduated as MD in 1951. First step of her medical career was a clinical work in the small Pediatric City Hospital in Warsaw, where she organized the pediatric nephrology ward and outpatient clinic. She was graduated as PhD in 1961 discussing a thesis on the Impact of the pancreas – intrinsic system on course of experimental nephrosis). In 1975 she was promoted Associate Professor in 1975 by discussing a thesis on Studies on steroid-resistance in nephrotic syndrome in children. She was finally nominated professor of medicine in 1986. From 1978 to the retirement in 1999 she worked at The Children’s Memorial Health Institute in Warsaw, as the head of Nephrology Department. The major topics of her professional interest were glomerulopathies, including nephrotic syndrome in children and secondary (HBV-related) membranous nephropathy, peritoneal dialysis in acute and chronic renal failure in children and arterial hypertension in children and adolescents. The major personal achievements of Teresa Wyszyńska included the elaboration of diagnostic and therapeutic algorithms in nephrotic syndrome, including step-wise management, longer vs shorter steroid therapy and indications to renal biopsy; research on prostaglandins metabolism in nephrotic syndrome, elaboration of therapeutic strategy in HBV-related membranous nephropathy; – elaboration of diagnostic and therapeutic algorithms in pediatric hypertension, introducing acute peritoneal dialysis in intensive care and pediatric nephrology and introducing evidence-based medicine related procedures and algorithms in pediatric nephrology in Poland (2). Nephrotic syndrome was her beloved topic and the earliest and the last papers she published (40-years apart), were related to this disease (3, 4). She was serving as a head editor of Pediatria Polska/ Polish Pediatrics for many years and the editor and major author of the first handbook of pediatric nephrology ever issued in Poland in 1975 (5). She has published more than 150 papers and was the editor/co-editor of 10 handbooks related to renal diseases and hypertension in children. What was the co-workers personal recognition, asked to answer the question: “Who she was for us?” Here are the answers: she was the guru in paediatric nephrology, fair boss, extremely strict scientific editor, excellent tutor and lecturer, unique personality with huge sense of humor and far distance to her divine position. She extremely loved the dachshund dogs, always having one aside.

Prof. Wyszyńska promoted several careers. The list of her most prominent fellows includes (in alphabetical order) the following persons: Elżbieta Cichocka, Ryszard Grenda, Paweł Januszewicz, Anna Jung, Zofia Konopielko, Jerzy Kryński, Sylwester Prokurat, Anna Wieteska-Klimczak and Jan Zawadzki.

The other pioneer was Maria Sieniawska (Figure 2). She was born in Lvov and was graduated in 1951 at the Medical Academy Wrocław. Starting from 1952 she moved to the University Children’s Hospital in Warsaw. Her PhD thesis (1962) was titled Howard, Hopkins and Connor test in children. The habilitation thesis (1969) discussed Vitamin D action in children with impaired calcium absorption in the gastrointestinal tract. She was nominated as professor of medicine in 1983. From 1979 to 1998 she worked as head of Department of Pediatrics and Nephrology in Medical Academy in Warsaw. The major topics of her interest were calcium-phosphate metabolism, growth problems in children with renal failure including growth hormone substitution in uremic patients, hemo – and peritoneal dialysis and cow’s milk-related allergy in children with nephrotic syndrome. Her major personal achievements were:

  • introducing regular hemodialysis program in children (1976);
  • introducing CAPD program in children (1983) and introducing growth hormone substitution in uremic children (1986) in Poland.

Apparently the calcium-phosphate/vitamin D-related issues were her beloved topics and the first and the last publication (42 years apart) were related to this subject (6, 7). For here coworkers: (i) she was the authority who often made the very accurate diagnosis based of scant information; (ii) an inquisitive researcher with international recognition; (iii) she was very demanding from herself and the entire clinic team and was fully dedicated to the Nephrology Department and was expecting the same attitude from her team; (iv) she taught us a holistic view of the patient, courage in introducing cutting-edge technologies and treatments; (v) she mobilized everyone for personal development; and (vi) she was able to create a consolidated team. Her principal hobby was travelling.

Prof. Sieniawska promoted several careers. The list of her most prominent fellows includes (in alphabetical order) the following persons: Beata Frącka, Paweł Grzesiowski, Czesława Gura Antoni Jędrzejowski, Izabela Kostro, Grażyna Krzemień, Małgorzata Pańczyk-Tomaszewska, Maria Rudzińska, Maria Roszkowska-Blaim, Hanna Szymanik-Grzelak, Joanna Welc-Dobies, Beata Sobolewska-Wojciechowska, Jarosław Sołtyski, Jolanta Węglarska, and Helena Ziółkowska.

The third lady pioneer in pediatric nephrology was Marta Uszycka-Karcz (Figure 3). She was born in Warsaw and was graduated in the Medical Academy in Gdansk in 1958. Her PhD thesis (1969) was related to Immunoglobulins in acute nephritic syndrome; in her habilitation thesis (1978) she discussed Immunosuppression in children with nephrotic syndrome. In 1990 she was nominated as professor of medicine. Starting from 1985 she was the head of the Paediatric Nephrology Department of Medical Academy in Gdansk. The major topics of her interest were hemolytic-uremic syndrome (clinical manifestation, long term outcome and prognostic factors for poor outcome), nephrotic syndrome (epidemiology, kidney biopsy, immunosuppressive treatment); fate of dysplastic kidneys and dialysis therapy in children. Her major achievements were: 1. the organization of the first outpatient unit of pediatric nephrology (1972) in Northern Poland; 2. the organization of the first pediatric nephrology ward (further Department) in northern Poland with facilities for AKI treatment (PD 1971, HD 1985) and CKD (HD 1985, CAPD 1983); 3. introduction of peritoneal dialysis for AKI, HD and CAPD for CKD in children (60-ties, 80-thies of 20th century; respectively); 4. introduction of automated system for peritoneal dialysis in AKI (1981); 5. introduction of diagnostic renal biopsy in children with nephrotic syndrome; 6. raising awareness on HUS as a cause of AKI in children; 7. introduction of an algorithm for prognosing outcome in hemolytic–uremic syndrome and 8. introduction of risk factors and computed algorithms for outcome in clinical studies. Apparently the hemolytic-uremic syndrome was her beloved topic, as one of the early and of the last publications was related to this disease (8, 9).
Her coworkers recognized her as: (i) a warm, socializing personality; (ii) a dear friend for her contemporaries and a role figure for her younger colleagues and students; (iii) an exceptionally righteous, reliable and compassionate person and physician; (iv) active Solidarity (social movement) member and fighter for human and political rights; (v) a leader an excellent organizer and teacher; (vi) an open-minded researcher with international recognition and a charming, beautiful lady. Prof. Uszycka-Karcz promoted several careers. The list of her most prominent fellows includes (in alphabetical order) the following persons: Zofia Gockowska, Halina Kaminska, Bogusław Karpowicz, Ewa Marczak, Krystyna Schramm and Aleksandra Żurowska.

One the common ways of three pioneers was related to achievement of the leading positions in scientific societies related to pediatric nephrology. Teresa Wyszyńska was a participant of the foundation meeting of European Society for Paediatric Nephrology (ESPN) in Glasgow in 1967 (10). In 1964 the Polish Society of Internal Medicine established Nephrology Section, gathering “adult” nephrologists and including two pediatricians related to the care of renal diseases in children. One of those two was Teresa Wyszyńska. In 1973 the Council of Polish Paediatric Society authorized Teresa Wyszyńska to organize the Paediatric Nephrology Section. It was launched in 1975 and Marta Uszycka- Karcz was elected as the first leader. In 1978 the first conference of the Pediatric Nephrology section was organized by Marta Uszycka-Karcz in Gdańsk. In 1994 the Polish Pediatric Nephrology Association (PPNA) was established basing on the initiative of the pediatricians treating renal disease in children. First Presidents were Teresa Wyszyńska (1994-1997) and Maria Sieniawska (1997-2000). All three ladies became the honorary members of Polish Pediatric Nephrology Association in recognition of their activity.

All three leading pioneers have passed away: Marta Uszycka-Karcz in 1990, Maria Sieniawska in 2012 and Teresa Wyszyńska in 2014.

Summary

  • All three ladies were charismatic physicians, teachers and persons
  • They represented “old golden standard” of being academic professor, head of the medical department and the president of scientific society
  • They developed and established the best clinical practice and research in paediatric nephrology of 70 – 90 – ties of 20th century, available in Poland
  • Many of currently active leaders of paediatric nephrology in Poland grew –up under their supervision
  • All remain in our loving memory

 

References
  1. www.womeninnephrology.org
  2. Grenda R (2003) Professor Teresa Wyszynska: great nephrologist – my master. Pol Arch Med Wewn 110(4):1070-1072
  3. Raszek J, Wyszynska T (1955) The role of lipocaic hormone in pathogenesis of lipoid nephrosis syndrome. Pediatr Pol 30(4):307-312
  4. Ksiazek J, Wyszyńska T (1995) Short versus long initial prednisone treatment in steroid-sensitive nephrotic syndrome in children. Acta Paediatr 84(8):889-893.
  5. Wyszyńska T (1975) Choroby układu moczowego u dzieci, PZWL, Warszawa
  6. Sieniawska M (1958) Diagnostic difficulties in parathyroid insufficiency –  based on a case report. Pediatr Pol 33(5):577-582
  7. Pańczyk-Tomaszewska M, Ziółkowska H, Dębiński A and Sieniawska M (2000) Vitamin D metabolite requirements in dialysed children receiving recombinant human growth hormone. Nephrol Dial Transplant.15(3):375-378.
  8. Uszycka-Karcz M, Chodorowski Z (1975). Hemolytic-uremic syndrome. Pol Tyg Lek 30(21): 899-902
  9. Uszycka-Karcz M, Marczak E, Mierzewski P, et al. Prognostic factors in the hemolytic-uremic syndrome (1989). Child Nephrol Urol 9(5):264-268.
  10. Arneil G, Boda D, Ehrich JHH, et al (2007). The founding and early history of the European Society for Paediatric Nephrology (ESPN). Pediatr Nephrol 22:1-15
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