Harlos J, Heidland A
Department of Medicine, University of Würzburg, Germany.
Am J Nephrol. 1994;14(4-6):436-42. doi: 10.1159/000168761.
The pioneering work of Richard Bright, who introduced the concept of the renal origin of cardiovascular disease, initiated the continuous unfolding of knowledge on renal disease and its close interrelationship with arterial hypertension in the 19th century. Hypertension as a clinically and pathologically defined entity, however, was not established. The partial elucidation of the problem that the diseased kidney was sometimes the cause and sometimes the consequence of elevated blood pressure is not only fascinating but also remarkable, given the crude techniques available to physicians at that time. Subsequent workers came to regard 'Bright's disease' as consisting of several conditions differing in clinical manifestation and pathology. In particular, Johnson and Gull and Sutton drew attention to the small blood vessels in renal disease. Only the invention of a clinically applicable method of measuring blood pressure indirectly allowed Mahomed and Allbutt to show that hypertension may occur in the absence of renal disease. They paved the way for a clear separation of hypertensive renal disease from other forms of 'Bright's disease', culminating in the classification introduced by Fahr and Volhard.
理查德·布莱特的开创性工作引入了心血管疾病源于肾脏的概念，开启了19世纪对肾脏疾病及其与动脉高血压密切关系的知识不断拓展的进程。然而，高血压作为一个临床和病理上定义的实体尚未确立。鉴于当时医生可用的技术简陋，患病肾脏有时是血压升高的原因，有时又是其结果这一问题的部分阐明不仅引人入胜，而且意义非凡。后来的研究者开始认为“布莱特氏病”由几种临床表现和病理不同的病症组成。特别是约翰逊、古尔和萨顿关注到了肾脏疾病中的小血管。只有临床上适用的间接测量血压方法的发明，才使穆罕默德和奥尔巴特得以证明高血压可能在无肾脏疾病的情况下发生。他们为将高血压性肾病与其他形式的“布莱特氏病”明确区分开来铺平了道路，最终形成了法尔和福尔哈德引入的分类方法。
