The history
From reading urine in a flask and cutting out stones to a machine that cleans blood and a kidney that can be given away.
For thousands of years doctors studied urine without knowing how it was made. Galen showed it comes from the kidneys, microscopes revealed their tiny filters and tubes, and physiologists worked out that blood pressure filters the blood and the tubules take most of it back. In the 20th century machines learned to do the kidney's job, surgeons learned to transplant one, and India built one of the world's largest transplant programmes.
2nd century CE
Experiment showing urine is made by the kidneys
Galen, Roman Empire
1666
Glomeruli described
Marcello Malpighi, Italy
1945
Dialysis patient to survive
Willem Kolff, Netherlands
1954
Successful kidney transplant
Joseph Murray, USA
1971
Kidney transplant in India
Mohan Rao and K. V. Johny, CMC Vellore
1980
Shock-wave treatment of a kidney stone
Dornier and LMU Munich, Germany
500 BCE – 1600
Doctors study urine and remove stones, and Galen shows the kidneys make urine.
400 BCE
c. 400 BCE (Hippocratic writings, dates uncertain)
Greek doctors of the Hippocratic school looked closely at urine to judge illness. One of their Aphorisms says that bubbles sitting on the urine point to disease of the kidneys, and a long illness.
Why it mattered. Foamy urine is still a warning sign today: it can mean protein is leaking through damaged filters.
300 BCE
compiled over centuries, c. 1st millennium BCE to early centuries CE (dates debated)
The Sushruta Samhita, a Sanskrit surgical text built up over several centuries, describes how to remove a stone from the bladder through a cut in the perineum, with the patient held in position. It lists stones among the hardest diseases to treat.
Why it mattered. It is one of the oldest detailed descriptions of stone surgery, a problem people have fought for thousands of years.
170
2nd century CE
Some doctors of his day said urine simply seeped into the bladder. In On the Natural Faculties, Galen describes tying off the ureters of a living animal: the bladder stayed empty while the ureters above the knot swelled with urine.
Why it mattered. It was an early experiment showing that urine is made in the kidneys and carried down the ureters.
900
c. 900 CE
The Persian physician al-Razi wrote a treatise on stones in the kidney and bladder, describing their symptoms, how they differ, and how to treat them. His works were later translated into Latin and read in Europe for centuries.
Why it mattered. It set out kidney stones as a disease to be studied carefully, not just endured.
1300
c. 1000 to 1600 CE
For centuries, looking at urine in a round glass flask called a matula was a doctor's main test. Colour charts linked each shade to an illness. Much of it was guesswork, and by the 1600s critics mocked 'piss prophets'.
Why it mattered. It showed that urine carries clues about the whole body, the idea behind modern urine tests.
1600 – 1870
Microscopes reveal tubes, glomeruli, capsules and loops, and a doctor links kidney disease to protein in urine.
1662
At about 19, Bellini published a study of the kidney's structure. He showed that it is not a solid lump of flesh but is full of tiny tubes that carry urine towards the pelvis. The collecting ducts are still called the ducts of Bellini.
Why it mattered. It was the first sign that the kidney works through countless tiny tubes.
1666
Using an early microscope, Malpighi described small round bodies scattered through the kidney's outer layer, linked to its blood vessels. We now call them glomeruli; for a long time they were known as Malpighian bodies.
Why it mattered. He found the filters of the kidney, though nobody yet knew what they did.
1827
Bright linked three things in his patients: swelling of the body, protein in the urine (it thickened when heated in a spoon) and hard, damaged kidneys seen after death. For a century, kidney disease of this kind was called Bright's disease.
Why it mattered. It was the first time a disease was clearly tied to the kidneys by testing urine at the bedside.
1828
Wöhler made urea, the main waste in urine, from chemicals that had nothing to do with living things. Urea is made by the liver from spare protein and removed by the kidneys.
Why it mattered. It helped show that the body's chemistry follows the same rules as any other chemistry.
1842
Bowman showed that each glomerulus sits inside a cup that is the blind end of a tubule, so blood vessels and the urine tube meet there. He suggested that water leaves the blood in the glomerulus. The cup is named after him.
Why it mattered. It revealed the basic plan of the nephron: a filter joined to a tube.
1844
Ludwig proposed that blood pressure pushes fluid out of the glomerulus by plain physical filtration, and that the tubules then change it on its way. Many scientists thought only a 'vital force' could make urine.
Why it mattered. His filtration idea is the basis of how we explain the kidney today.
1862
In his book Zur Anatomie der Niere, Henle described the hairpin loop that the tubule makes deep into the medulla, with drawings of its thin and thick parts. For almost a century nobody knew what it was for.
Why it mattered. It is the part of the nephron that lets us make concentrated urine.
1890 – 1960
Hormones, micropuncture and clearance tests explain filtering, reabsorbing and concentrating.
1898
Tigerstedt and his student Bergman found that an extract of rabbit kidney raised blood pressure when injected. They named the substance renin.
Why it mattered. It was the first clue that the kidneys help control blood pressure with hormones.
1906
Carnot and his colleague Deflandre reported that blood from anaemic rabbits made other rabbits produce more red blood cells, and proposed a hormone behind it. The idea was debated for decades before it was proved.
Why it mattered. It started the search for erythropoietin, which turned out to come mainly from the kidneys.
1924
Using very fine glass pipettes, Richards and Wearn drew fluid straight out of Bowman's capsule in frogs. It had sugar and salt but no protein, just as filtration predicts.
Why it mattered. It settled an argument that had run for about 80 years: the glomerulus filters.
1935
1930s to 1950s
Smith and his colleagues used inulin, a sugar that is filtered but neither taken back nor added by the tubules, to measure how fast the kidneys filter. His 1951 book The Kidney gathered what was known.
Why it mattered. It gave doctors a way to put a number on kidney function, like the eGFR used today.
1951
Kuhn, a physical chemist, and Hargitay argued that the hairpin shape of the loop of Henle could build up saltiness step by step. Wirz measured rat kidneys and found the medulla gets saltier towards the tip. The idea was confirmed by Gottschalk and Mylle in 1958.
Why it mattered. It finally explained what Henle's loop is for: concentrating urine.
1924 – 1990
Dialysis machines, transplants, fistulas and shock waves change what kidney failure means.
1924
Haas passed a patient's blood through tubes of collodion membrane bathed in fluid for a short time. It did not save patients, but it showed that blood could be cleaned outside the body.
Why it mattered. It was the first step towards the artificial kidney.
1945
1943 (first machine); 1945 (first survivor)
During the Second World War, Kolff built a dialysis machine from sausage casing wound round a rotating drum in a bath of fluid, using parts such as orange-juice cans and car parts. His first patients died, but in 1945 a 67-year-old woman survived.
Why it mattered. It was the first dialysis machine to save a life, and the start of modern dialysis.
1954
23 December 1954
Ronald Herrick gave a kidney to his identical twin, Richard, whose kidneys were failing. Because they were identical twins, the body did not reject the kidney. Richard lived eight more years. Murray shared the 1990 Nobel Prize.
Why it mattered. It proved that a transplanted organ can work, and that one kidney is enough for a donor.
1960
Scribner's team made a U-shaped Teflon tube that stayed in a patient's arm, joining an artery to a vein, so dialysis could be repeated for years. Their first patient, Clyde Shields, lived more than 11 years. The first outpatient dialysis centre opened in Seattle in 1962.
Why it mattered. Dialysis changed from a one-off rescue into a treatment people could live on.
1966
Surgeons joined an artery straight to a vein in the forearm. The vein grows big and strong, so it can be used for dialysis again and again without a tube left in the skin.
Why it mattered. The fistula is still the preferred way into the blood for haemodialysis.
1976
Popovich and Moncrief worked out continuous ambulatory peritoneal dialysis: fluid is left in the belly and swapped a few times a day, so wastes pass across the belly's own lining. People could do it at home.
Why it mattered. It gave people with kidney failure an option without a machine.
1977
1977 (purified); 1989 (medicine approved)
After years of work, Goldwasser's team purified human erythropoietin from a large amount of urine. The gene was later cloned and, from 1989, man-made EPO was used for anaemia in people with kidney failure.
Why it mattered. It proved the kidney makes a hormone for red blood cells, and turned it into a medicine.
1980
February 1980
A machine from Dornier, an aircraft company that had studied shock-wave damage, focused shock waves on a kidney stone from outside the body while the patient lay in a water bath. The stone broke into bits small enough to pass.
Why it mattered. Many stones could now be treated without cutting the body open.
1970 – today
India's first transplant, laws on donation, CKD stages and free dialysis.
1971
2 February 1971
Seventeen years after Boston, a team led by surgeon Mohan Rao and nephrologist K. V. Johny carried out India's first successful kidney transplant, from a living donor. They worked at night after normal hours and had prepared two donor-recipient pairs.
Why it mattered. It started kidney transplantation in India, now one of the largest programmes in the world.
1994
The Act set rules for organ donation, recognised brain death so that organs could be donated after death, and banned buying and selling organs. It was amended in 2011 and extended to tissues.
Why it mattered. It is the legal backbone of organ donation in India.
2002
Experts defined chronic kidney disease by filtration rate and kidney damage, and split it into five stages. An international group, KDIGO, later refined them and added protein in the urine.
Why it mattered. Doctors everywhere could now describe and track kidney disease the same way, as in the CKD stages you can explore here.
2016
7 April 2016
India launched the Pradhan Mantri National Dialysis Programme under the National Health Mission, to give free dialysis to poor patients at district hospitals. By the end of 2022 it ran in all 36 states and union territories.
Why it mattered. Dialysis moved closer to home for many families who could not afford it.
2023
India recorded about 13,400 kidney transplants in 2023, most from living donors, many of them women giving a kidney to a relative. The total of all organ transplants had more than tripled in ten years.
Why it mattered. Yet it is still far fewer than the number of people whose kidneys fail each year.
By the numbers
Global Burden of Disease 2023: the number of adults with CKD roughly doubled between 1990 and 2023, as populations grew, aged and more people developed diabetes and high blood pressure.
By the numbers
Kidney transplants reported in India: most come from living donors.
Did you know?
Your kidneys filter about 180 litres of fluid a day, and send about 99% of it back into your blood.
A Greek aphorism from about 400 BCE already linked bubbles on urine to kidney disease. Foamy urine can still mean protein is leaking.
Kolff's first artificial kidney used sausage casing wound round a drum, built partly from orange-juice cans and car parts in wartime.
The first successful transplant worked because donor and patient were identical twins, so the body did not see the kidney as foreign.
The first shock-wave stone machine came from Dornier, an aircraft maker that had studied how shock waves damage planes.
The people
dates uncertain · Surgeon (attributed author) · India
The surgical text named after him describes removing bladder stones.
1789 – 1858 · Physician · England
Linked swelling, protein in urine and damaged kidneys.
1816 – 1892 · Surgeon and anatomist · England
Found the capsule that catches the filtrate.
1816 – 1895 · Physiologist · Germany
Said blood pressure drives filtration.
1911 – 2009 · Physician and inventor · Netherlands
Built the first dialysis machine to save a patient.
1919 – 2012 · Surgeon · USA
Led the first successful kidney transplant; Nobel Prize 1990.
1921 – 2003 · Nephrologist · USA
His shunt made long-term dialysis possible.
1895 – 1962 · Physiologist · USA
Measured how fast the kidneys filter, and wrote the classic book The Kidney.
Where it happened
Sources
Dates marked “c.” are approximate, and historians sometimes disagree about who was first. If you spot a mistake, tell us.
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