Renal Disease *

The title of this talk is extremely broad. Obviously I cannot pretend to cover the field of renal disease in a single lecture. All I intend is to express a point of view and to suggest an attitude or approach to the subject. Attention will be directed particularly to those diseases that lead to deterioration of the function of the kidneys accompanied by vascular disorders , especially hypertension. These entities are conventionally divided into two chief categories: those which originate in diseases of the kidney and those in which the primary disorder is arterial. The latter is in turn frequently divided into two classes: those in which there are definite morphological changes in the arteries and those in which hypertension appears without morphological arterial equivalents. There is ample experimental and pathological evidence that hypertension and vascular disease may be produced by renal disorders; there is no comparable body of data to support the concept of primary or essential hypertension and hyper-tensive vascular disease. What there is would suggest that its causes might be legion. The terms essential and idiopathic, applied to hypertension, are merely declarations of ignorance, labels for the scrap-basket into which are dumped all cases that have hypertension for which no obvious-and particularly no renal-origin can be found. Recognition of this fact would, I think, hasten discovery of the nature and causes of these conditions by promoting inquiry; the attachment of polysyllabic labels has throughout medical history created such mental and spiritual satisfaction that it has tended to stifle curiosity. I cannot refrain from putting in a plea for more careful study of the natural history of disease. Though it may seem inappropriate to this advanced era, much of our knowledge of renal diseases was acquired through this channel and its potentials are not yet exhausted. I should be the last person to disparage investigations of function; but I believe that on the whole they are likely to contribute more to therapy and prognosis than to pathogenesis and diagnosis. About 1920 the ardor for classification of renal disease by an infinite number of nomenclatures based on every imagin-able criterion began to cool down; or at least seemed to many thoughtful