The Kidney

‘Concerning the Kidneys, he first relates what hath been taught of them hitherto; and then delivers his own observations about them, by a long use of the Microscope, and his deductions from them’.

Review of Marcello Malpighi’s De Viscerum Structura Excertatio Anatomica
(Bologna, 1666) in Philosophical Transactions of the Royal Society,
vol 3, issue 44 (1669), 889-890.

Bartholomeo Eustachio, Opuscula anatomica (Leiden, 1707), Tabula prima.

Bartholomeo Eustachio (d. 1574), professor of anatomy at the Sapienza in Rome, produced some of the most important early modern depictions of the kidney. These were copperplate engravings, 47 in all, which he had designed to complement a projected text called De Dissensionibus ac Contraversiis Anatomicis. Unfortunately, the text never saw the light of day, and the plates were only fully published in 1714 by Giovanni Maria Lancisi (1654–1720) in Tabulae Anatomicae clarissimi viri Bartholomaei Eustachi (Rome, 1714). Thus, the majority of the illustrations remained unknown to that date. However, Eustachio used some of his plates to illustrate his first anatomical work, Opuscula Anatomica (Venice, 1564), and one of them is depicted above, from  Worth’s copy of the Leiden 1707 edition. It demonstrates that Eustachio was a perfectionist:  one can see this in his use of co-ordinates in the above image, which he used as a key to his work, preferring not to mar his image by adding letters as a key. One can perhaps also see his perfectionism in his use of copperplate engraving, which, as Eknoyan says, ‘marks a turning point in the study of the kidney’.^[1]

Purckerson and Wechsler list several important observations made by Eustachio concerning the kidney: ‘he was the first to describe the adrenal glands, he noted correctly that the right kidney is lower than the left, he clearly and accurately illustrated the intrarenal vasculature, he was the first to describe the renal calyceal system and its relation to the renal papillae’.^[2] These were only some of Eustachio’s many observations on the structure of the kidney.

The delay in publishing Eustachio’s principal text meant that, despite the fact that he had correctly described the renal collecting ducts of the kidney, credit for their description was given to a later Italian anatomist, Lorenzo Bellini (1643–1704). In his book on the structure and use of the kidney, initially published in 1662, which Worth had in a 1726 Leiden edition, Bellini demonstrated that the kidney was not solid, but was made up of ducts, now known as ‘Bellini ducts’, which can be seen his figure 5 below.

Lorenzo Bellini, Exercitationes anatomicae duae de structura et usu renum ut et de gustus organo novissime deprehenso (Leiden, 1726), Fig. 1-7: Figure 5 depicts the ‘ducts of Bellini’.

While studying at the University of Pisa Bellini has been a student of Giovanni Borelli (1608–79), whose De motu animalium likewise Worth owned in a 1680 Rome edition. It offered its readers an iatromechanical view of the human body and noted that one of the functions of the kidney was to purify blood. Borelli’s treatise was one of a number of physiological texts owned by Worth which included examinations of the physiology of the kidney. One of the most influential sixteenth-century texts was his copy of the French physician Jean Fernel’s Physiologia in his Universa medicina (Frankfurt, 1592). In his discussion of the kidney Fernel (1497–1558), concentrated on the function of the organ and also on the principal causes of kidney disease, albeit in a Galenic framework. In the seventeenth century, besides the iatromechanics of Borelli, Worth also possessed texts advocating the application of the iatrochemistry of Jean Baptist Van Helmont (1577–1644), and the Newtonian hydraulic theory to processes in the kidneys.^[3]

Of even more importance was the application of new technology to the study of the kidney: both Bellini and Marcello Malphigi (1628–94) trained their microscopes on the kidney to yield new exciting discoveries. Malpighi, who taught at the universities of Bologna, Pisa and Messina, is particularly known as the founder of microscopic anatomy. His work on the kidney is commemorated by the Malpighi pyramids (sections of the renal medulla) and Malpighian corpuscles, which filter blood in the nephron of the kidney. Even in death, Malpighi furthered understanding of the anatomy of the kidney, for the report on his autopsy (which noted an enlarged right kidney), is one of the thousands of autopsy reports in Worth’s copy of the Swiss physician Théophile Bonet’s Sepulchretum sive anatomia practica ex cadaveribus morbo denatis (Geneva 1679).

In anatomy, it is often the exception that proves the rule. As Irish anatomist Andrew Francis Dixon (1868–1936) asserts in his case study on the subject, a supernumerary (additional) kidney is rather rare. This particular specimen was found in the dissection lab in Dixon’s Class of Practical Anatomy at Trinity College Dublin.

‘The occurrence of a supernumerary kidney has been so rarely noted that it seems worth while to place on record an illustration and a short description of a case recently met with in the Class of Practical Anatomy, Trinity College, Dublin. The subject in which the third kidney was present was a man of about forty-five years of age, and did not present any congenital abnormalities other than those connected with the urinary organs. The kidney on the right side was normal in all respects and measured 95 cm. in length. Its ureter and vascular supply were normally disposed. On the left side two kidneys, of approximately equal size, were present, lying one above the other, and separated by an interval of 2:8 cm. They were both readily recognised when the abdomen was opened. The upper left kidney possessed a typical outline, and occupied the usual position of a normal left kidney. It measured 77 cm. in length. The lower left kidney lay partly in the left iliac fossa and partly on the quadratus lumiiborum muscle, its middle point being upon a level with the bifurcation of the aorta’.^[4]

Dissection showing a supernumerary kidney in an adult male. Prepared by Prof. Andrew Francis Dixon, 1910. Courtesy of the Old Anatomy Museum, School of Medicine, Trinity College Dublin.

Dixon notes that there are no renal anomalies related to the third kidney and all other anatomy is ‘normally presented’. It is believed that this congenital abnormality occurs as an error in duplication during foetal development resulting in a ‘duplex’ kidney on one side. There are less than a hundred such cases recorded in literature to date, ten of which Dixon discusses in his paper.^[5] He went on to exhibit the specimen at the International Congress of Anatomists in Brussels in 1910.

Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, and Ms Evi Numen, the Curator of the Old Anatomy Museum, Trinity College Dublin.

Sources

Dixon, A. F. ‘Supernumerary Kidney: The Occurrence of Three Kidneys in an Adult Male Subject’, Journal of Anatomy and Physiology, 45, no. Pt 2 (1911), 117-21.

Eknoyan, Garabed, ‘The Renaissance Kidney – Nephrology in and about the Sixteenth Century’, Seminars in Dialysis, 25, no. 4 (2012), 451–9.

Eknoyan, Garabed, ‘The Scientific Revolution – The Kidney and Nephrology in and about the Seventeenth Century (part 1)’, Seminars in Dialysis, 28, no 3 (2015), 282–92.

Eknoyan, Garabed and Natale D. De Santo, ‘The Enlightenment Kidney – Nephrology in and about the Eighteenth Century’, Seminars in Dialysis, 25, no 1 (2012), 74–81.

Purkerson, Mabel L. and Lilla Wechsler, ‘Depictions of the Kidney through the Ages’, Am. J. Nephrol., 17 (1997), 340–46.

Sureka B. et al., ‘Supernumerary kidneys–a rare anatomic variant’, Surg Radiol Anat., 36, no. 2 (2014), 199-202.

^[1] Eknoyan, Garabed, ‘The Renaissance Kidney – Nephrology in and about the Sixteenth Century’, Seminars in Dialysis, 25, no. 4 (2012), 453.

^[2] Purkerson, Mabel L. and Lilla Wechsler, ‘Depictions of the Kidney through the Ages’, Am. J. Nephrol., 17 (1997), 342.

^[3] Worth owned copies of works by both authors.

^[4] Dixon, A. F., ‘Supernumerary Kidney: The Occurrence of Three Kidneys in an Adult Male Subject’, Journal of Anatomy and Physiology, 45, no. Pt 2 (1911), 117-21.

^[5] Sureka, B. et al., ‘Supernumerary kidneys–a rare anatomic variant’, Surg Radiol Anat., 36, no. 2 (2014), 199–202.