Lively Liver and Kind Kidneys

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Liver is single, kidneys are in a pair. Our hollow intestines absorb whatever we eat or drink, and send it to more solid liver to process. It’s cells undergo a flurry of activities. Liver cells create substances, store nutrients, and let-go of things we do not need. Feed makes it busy, and starvation busier as now it needs to dole out stored nutrients. Thus “lively liver” is a storehouse of energy and enthusiasm. All organs in our body become livid with liver’s enthusiasm, sing, dance, and pass on their residues.

Kidneys, receive all the junk and sort out trash. They clean-up when party is all over. Kidneys are kind enough to process all we give them, with same diligence, all the time. Failure does not deter either liver or kidneys to give up. They fight hard to attempt being lively and kind again.

It’s only in last seventy years, we have learned how to keep ourselves going when failing kidney and liver have no means to recover. Today we can change failing organs, but this path is still tough. Only a right person, at a right time, and at a right place can donate these organs for someone else in need. Let’s discover how we have come so far in our understanding of liver and kidneys, and we have miles more to go.

Pioneers in structure and function

While Kidney’s role as a producer of urine was never in doubt, liver was more of a curiosity. It was an organ so important that ancient Greeks used it to make divine predictions. Ancient Greeks inspected liver of a sacrificed animal, to inform kings about impending success or failure. Till the Middle Ages, liver was seat of soul, emotions, feelings, desires, sexuality, and generator of blood (sanguification officina). Leonardo da Vinci (1425-1519) and Andreas Vesalius (1514-1564) were first to dissect, document, illustrate and detail liver, kidneys, spleen and many other organs.

William Harvey (1578-1657) demonstrated that all organs are connected by the same blood-supply. Function of both liver and kidneys depends on their rich blood supply. Subsequent push in our understanding came from Marcello Malphigi (1628-1694), an Italian biologist. He discovered “Malphigian corpuscles“, a group of cells in kidney, that perform filtration. He also described cells in liver, as arranged in clusters or lobuli and glandulosi acini. Today we know these as glomeruli and hepatic lobules respectively.

Understanding diseases of Liver and Kidneys

Jaundice (yellow eyes), Ascitis (fluid in abdomen), blood-vomits, and altered sensorium (encephalopathy) were all well known to the ancient physicians. Their linkage to liver was however not known. Rudolf Virchow (1821-1902) coined the term Catarrhal Jaundice, for acute hepatitis. He suggested that jaundice is due to a disease of duodenum, rather than Liver. This belief persisted till 1940s. Similarly Richard Bright (1789-1858), for the first time described that sometimes swollen body (or dropsy) is due to albumin leak in urine. This was Bright’s disease (or nephritis of today). Physiologists Claude Bernard (1813-1878), and Walter Cannon (1871-1945) discovered that kidneys are more than just a filter. They also maintain a balance or homeostasis in chemical composition of circulating blood.

Soft liver when diseased, becomes hard. Giovanni Morgagni (1682-1771) called such a liver Scirrhus or hard. Hardness of liver, and small protuberances that appeared on such a liver were a matter of speculation. Tubercles seen in tuberculosis, nodules seen in malignancy or gumma seen in syphilis were all competing to take their place. Renne Laennec (1781-1826) linked it rightly to alcohol and coined the word Cirrhosis (skirros=hard; Kirrhos=yellow). William Osler (1849-1919) a physician coined the term Laennac’s cirrhosis in his honour. Till the beginning of 20th century, there were no blood tests for either liver or kidney, nor did we know about any of the viruses.

Blood tests for Liver and Kidney

Till 1950s, our knowledge about diseases of liver and kidney was limited. In 1913 Van-Den Berg identified that excess bilirubin in blood, that gives a yellow colour to the eyes, has two forms. Later we knew that one part is elevated in liver diseases, and another in diseases of blood. We knew that blood-vomits are due to liver diseases. In 1950 Sangstaken and Blackmore perfected balloon inflation in the food-pipe to stop such bleeds. Blood tests for liver diseases (or what we know as liver function tests) were perfected only during 1950s. We developed first automated blood analyser in 1957, and only since then we could accurately measure serum creatinine (an important indicator of kidney disease). In fact terms nephrology (for diseases of kidney) and Hepatology (for diseases of liver) became popular only after 1960s.

Jaundice epidemics and Medical Ethics

By 1940s, some World War II army battalions had jaundice-epidemics. These epidemics of “catarrhal-jaundice” were of two types, A as infectious from a person to person; B as non-infectious or only in serum. These were all thought to be due to overcrowded barracks. After war was over, some researchers were interested to know more about diseases of liver. In UK in 1949, Sheila Sherlock (1918–2001) established a liver unit. This unit became an authority in Liver diseases, and remains a leader in new innovations till date.

Another brutal experiment was unfolding in 1950s in Willowbrook state school for mentally subnormal children, in New York. This was the Willowbrook experiment. Willowbrook researchers also published their findings in leading medical journals in 1960s. Researchers gave some mentally ill children, chocolates with “infectious hepatitis extract” to eat. They also gave some others “serum injections”. When some of these children developed hepatitis, researchers transfused them with convalescent sera from other children as a vaccine. Recovered children were infected again, to see if they were indeed protected. A human-ethics and child-rights nightmare, this experiment ceased only after 1965, when we knew that hepatitis is not so innocuous.

Discovery of Viral hepatitis

In 1965, Baruch Bloomberg chanced upon an unusual protein in a stored blood sample of an Australian aborigine. Bloomberg and his colleagues named it Australia antigen or Au. Initially they thought that Au is a protective antibody, and the same was also seen in blood samples from patients with Hemophilia, leukaemia (who recd blood transfusions), downs syndrome (who often lived in mental asylums), and also in many children in Willowbrook experiment. In 1967, we knew that Australia antigen was indeed a particle from hepatitis B virus. This discovery was made on 28th July, which we observe as World Hepatitis day.

Today, hepatitis B infection is found in many people in Asia, Africa and Oceania. Yellow fever and small pox vaccinations, untested blood-units, unabated use of unsterile hypodermic needles, and intramuscular antibiotic campaigns – have all contributed to its spread. In 1969, Bloomberg and coworkers developed Hepatitis B vaccine. Bloomberg received 1976 Nobel Prize for these discoveries. Soon Hepatitis B had became a global concern

Making transfusions safe

We started screen for hepatitis B in blood-banking in 1983. This was a time when HIV was also discovered, and its spread was also global. We also identified Hepatitis C, as a second cause of “serum hepatitis”. In later years, we improved blood-banking practices, as well as prevention and treatment for Viral hepatitis B and C. We had our first drug to treat Hepatitis B in 1998, and today we focus on prevention and early treatment for both hepatitis B and C. We observe 28th July every year as a World Hepatitis Day

Origin of Kidney and Liver transplant

Surgeons across the world were trying to transplant kidneys and livers from either animals or cadavers into other animals and even humans. All such attempts failed and it baffled all. First successful kidney transplant took place in 1954. Joseph Murray, a plastic surgeon used an identical twin as a live donor, and the recipient twin survived for years. Murray was awarded Nobel prize for this feat in 1990. Liver transplants were not far behind, and first failed attempt was made in 1963 by Thomas Starlz.

Human body rejects foreign tissues. This problem was solved after 1970s, when we discovered immune suppressing medicines, that prevented rejection. Today we have many individuals who have had successful transplants.

Liver and Kidney transplant in Postage stamps

Keeping our livers lively, and kidneys kind

We have a responsibility to keep our livers lively, and kidneys kind. If we are low on body-fat, consume less alcohol, exercise more, and get hepatitis vaccines – we can keep our livers lively. In addition, keeping our blood-pressures and sugars in control, will be kind to the kidneys. All toxins and insults to our body, have to pass through filters of liver and kidneys, two solid organs that keep us going.