Between the half of the 19th and the half of the 20th centuries, Richard Bright’s successors have a profound problem classifying diseases leading to uremia. The advent of immunology around the onset of the 20th century sheds new light on this issue, with the identification of immune-complex and antibody mediated disorders.
It also appears that chronic uremia results in extra-renal complications which includes arterial hypertension. With the development of blood-pressure monitors, it is realised that hypertension may in turn cause kidney damage.
Following the description of rhabdomyolysis –induced renal insufficiency during World War II bombings, acute renal failure is furthermore recognized as a diagnostic entity in its own right.
The most important advance during this period is the emergence of physiology. Using the experimental method advocated by Claude Bernard, scientists nicely show the kidney has a vital role in the milieu intérieur homeostasis. By the way, they formalise the concept of clearance, leading to the establishment of creatinine clearance as the standard measurement of kidney function in clinical pratice.