Reflections on the Early Development of Paediatric Nephrology
The need for timed urine collections in the early 1970s limited the accurate measurement of kidney function in children and young people. Collaborative work led by figures such as Professors Martin Barratt in London and George Schwartz in New York resulted in the development of formulae to estimate glomerular filtration rate (GFR) using serum creatinine - a transformative advance that enabled reliable assessment without timed samples.
Malcolm ‘Mac’ Holliday, an American paediatrician and physiologist, reframed the understanding of growth failure in children with chronic kidney disease (CKD). His research demonstrated that poor growth was primarily the result of inadequate nutrition rather than irreversible metabolic dysfunction. Holliday’s work on energy balance and the kidney’s role in metabolic regulation provided the foundation for nutritional strategies that supported normal growth and improved quality of life in children with CKD.
Further progress came with greater understanding of phosphate retention and secondary hyperparathyroidism, leading to dietary and pharmacological strategies - including phosphate restriction and the introduction of safer calcium-based binders. These treatments significantly reduced chronic kidney disease mineral bone disorder (CKD-MBD) in children and young people.
Paediatric dialysis and transplantation also evolved, requiring adaptations of techniques for small children with limited blood volumes and high metabolic demands. The growing emphasis on multi-professional care - involving nurses, dietitians, and educators - became a defining strength of the early paediatric kidney centres.
The development of UK paediatric kidney services was shaped by collaboration and advocacy. Early proposals in 1972 and 1980 for a network of regional centres were initially overlooked but later implemented following government support in 1983. These centres remain the foundation of paediatric nephrology care today.
Progress in paediatric nephrology has always been driven by collaboration, curiosity, and compassion - principles that continue to guide the field forward.
Paediatric Nephrology Milestones
1960s
- Shock management innovations → fluid resuscitation replaces noradrenaline infusions.
Early 1970s
- Development of estimated GFR (eGFR) for children (Barratt, Schwartz, Haycock).
- Early research links nutrition to growth in CKD (Mac Holliday).
- 1972: First UK proposal for regional paediatric nephrology centres.
Mid–Late 1970s
- Nutritional interventions, phosphate restriction, and phosphate binders reduce CKD-MBD.
- Paediatric dialysis adapted for small children; multidisciplinary teams form.
1983
- UK national paediatric nephrology centres established following government initiative.
1990s–2000s
- Refined eGFR and nutrition management; emphasis on patient-centred care and schooling.
2010s–2020s
- Sustained collaboration through European Society for Paediatric Nephrology (ESPN).
- Foundation laid for modern multidisciplinary paediatric kidney care.
Summarised from a talk by Professor Sir Cyril Chantler, 2017, with input from Professor Stephen Marks, 2025
ESPN 50 Years of Hope