Introduction by Dr. Kiyoshi Kurokawa:

This is the video archives of the International Society of Nephrology. In this video we interview Dr. Kenzo Oshima. Dr. Oshima was primarily responsible for establishing the Japanese Society of Nephrology in 1959 and also in the foundation of the International Congress and the International Society of Nephrology in 1950 with Professor hamburger and other founding members of the Society. In this video Dr. Nobuhiro Sugino, former Councillor of the International Society of Nephrology and one of the disciples of Professor Oshima interviews Dr. Oshima. Dr. Oshima remembers his days with nephrology in Japanese as well as with the International Society of Nephrology:

Period of Preparations:

NS: Today I am going to talk with Dr. Oshima about the history and future prospects of the International Society of Nephrology. The first meeting of the ISN was held in Evian, France in 1960. Before the meeting, various preparations were made but there are very few people who remember them now. I would like you to tell us about them.

KO: In July 1959, Professor Hamburger visited me. At that time Professor Mura of the Department of Neurology of KO University telephoned me and said he would like me to meet Professor Hamburger from France. We met in the medical office of the Second Department of Internal Medicine at the University of Tokyo since I knew it well. This was in the beginning of July 1959. It was the first time I met Professor Hamburger.

NS: Is Dr. Mura the one from the Department of Neurology?

KO: Yes he is. Dr. Mura had spent about two years studying at the Necker Hospital or somewhere in France and he probably got to know Professor Hamburger during that time.

NS: Was it at that time that Professor Hamburger mentioned that he wanted to establish the ISN?

KO: At that time Professor Hamburger came to Japan from Europe by the southern route and then returned home via the United States. He said he was thinking about establishing the ISN.

NS: Perhaps Professor Hamburger had heard your name when the Japan Society of Nephrology had been formed one year previously with you as President?

KO: I donít know why he wanted to speak to me but perhaps Dr. Mura told him about me. He stayed for about two days and then left for the United States soon after our meeting. In addition to saying that he wanted to form the ISN, Professor Hamburger had three or four microscope slides with him. He showed them to me and he wanted to discuss them with me. Therefore, although it was not my own laboratory, we went to a laboratory in the Second Department of Internal Medicine and borrowed a microscope. We looked at the findings and discussed them. These specimens mainly showed glomerulonephritis associated with hypertrophy of the basement membrane. I said that it was probably a case of chronic glomerulonephritis associated with nephrotic syndrome which had become chronic after an acute stage. He had various specimens and although I did not always agree with him, we discussed the findings for about 30 minutes.

NS: Was Professor Hamburger testing your ability?

KO: Perhaps he was. It seemed like that. He probably thought it would be a problem if I didnít understand anything about this type of nephritis. At that time interpretation of such findings was very difficult.

NS: Yes, there were no electron microscopes at that time.

KO: The basement membrane was hypertrophied and some specimens showed cell proliferation and some not. The discussion was very cordial. Professor Hamburger also sometimes mentioned Masuki nephritis.

NS: That is something Japan is proud of.

KO: Masuki nephritis was created in Japan and Professor Hamburger evaluated it very highly as the first experimental nephritis which could be applied clinically.

First Stage of the Foundation of the ISN:

NS: Was the first meeting of the ISN held in Geneva in 1960?

KO: No. There was a meeting in Geneva but this was after the founding of the ISN. The first meeting was in Evian. Strictly speaking, after one conference in Geneva on August 31st, 1960 with Professor Mach? of the Mach syndrome as chairman, a meeting on various topics related to nephrology took place until the evening. We were told that we had to move to Evian the next day. So, we asked how to get to Evian at the hotel. We were very busy the next morning. We were told that there would be a boat from Geneva at around noon which took 40-50 minutes to reach Evian. I had been assigned a hotel to stay at in Evian so once I arrived I felt relaxed although I had been slightly confused on how to get there. As soon as I arrived, a letter came stating that a Board of Directors meeting would be held. The Board of Directors met in the evening of the day before the scientific meeting. At that meeting we discussed the establishment of the ISN. Among the 18 participants at that meeting, two could not understand English and I could not understand French. The Board of Directors meeting was held in French so it was a problem for me. Since I did not understand French at all, I could not understand what was being discussed but fortunately the English representative sitting next to me translated into English. Business meetings were held for four days. After breakfast from 7:00 a.m. to 8:00 p.m. Since these meetings were in French, I got confused within an hour or so.

NS: I have heard that there were 300-400 attendees. Is that true?

KO: In total there were about 400 participants. As you know, the ISN ship was at the official banquet. Actually, the idea was for the ship to leave with Professor Hamburger as the Captain. Although there were less than 100 people at the banquet, since about 400 people participated in the conference, Professor Hamburger said that it seemed to include almost all of the nephrologists in the world. Because nephrology was a new field, 400 nephrologists gathered together at a meeting was a major event.

NS: That ship became the symbol of the ISN, didnít it?

KO: Yes it did. The ship was placed in the centre of the room at the official banquet. Professor Hamburger launched the International Nephrology Ship. There is a scene where the ship was actually pulled around a little.

Subsequent Expansion of the ISN:

NS: Since that time, the ISN has held a congress every three years. How long were you Vice-President of the ISN?

KO: I served two three-year terms until the Congress in Washington, D.C. in 1966. I attended the next Congress in Stockholm and I served as the Japanese representative until that time.

NS: Did you visit Professor Hamburger at the end of the first Congress?

KO: Yes. Professor Hamburger visited me in Japan every year and I would see him at the congresses. I also met him when he was Chairman of the Board of Directors for establishment of the ISN. But we didnít have time for friendly discussions. Therefore, after the Evian meeting, I took the train to Paris via Geneva and visited the Necker Hospital. Professor Hamburger was very glad to see me and we talked about various things.

NS: Professor Hamburger was probably very happy that the first meeting was over?!

KO: Yes he was. He was very happy that we were able to hold a congress on nephrology. The impression that remains with me is that for more than one hour we talked about the popular topic of transplantation on the first day together with Dr. Merrill, including the so-called typing of transplantation. How to do it with more precision and how to prevent rejection reactions.

NS: He was a pioneer in HLA typing wasnít he?

KO: Since I had obtained an electron microscope in Japan, and was able to perform typing, I think this was pioneering in the area of kidneys. However, I remember the woman doctor named Farquhart? already had the electron microscope data.

NS: After that the Congress was held in Tokyo. Why was it finally decided to hold the Congress in Tokyo after it had been a candidate several times before.

KO: At the time of the Congress in Washington D.C. in 1966, there was a definite rumor that the next Congress would be held in Tokyo and not only Japanese, but people from various other countries told me that the next Congress would be held in Tokyo. Many of the 18 members of the Board of Directors said that it would be held in Tokyo but there were a few people who objected to this. They said that if the Congress were held in Tokyo, the round trip airfare for 200 young investigators would have to be paid so that they could attend. At that time, airfares were expensive - about 20 fares could be paid but not 200. For that reason, the next Congress was held in Stockholm rather than Tokyo.

NS: At the Board of Directors meeting during the Los Angeles Congress it was decided to hold the Congress in Tokyo six years later. As a result, the 11th Congress of the ISN was held in Tokyo in 1990. As President of the Congress what were the main things that were achieved by the Congress?

KO: I thought that this was a step that the Japanese Society of Nephrology had to take. In addition, to the three people I mentioned before, Professors Hatano and Sugino and many other people helped to establish the Japanese Society of Nephrology. If we didnít hold the ISN Congress once, we thought that the Japanese Society of Nephrology wouldnít come of age. We thought that it was not only necessary to host the Congress but also to convince others that it was good to have the Congress in Japan. Holding the Congress in Japan was decided in Los Angeles as a result of various preparations made by Dr. Sugino, Kurokawa and others. For the next six years I thought only of how to make the Congress a success. The two pillars of success were the financial aspect and the preparation of a program by the program committee. Dr. Sugino did a really good job so I was really very happy. The Japanese Society of Nephrology had come of age and it became necessary to publish many papers in the west in the future. So now thanks to everyoneísí efforts, we have an excellent English journal. Holding the ISN Congress in Japan also served as the springboard for this. I was very happy that everything went so well.

NS: It should not be forgotten that the Crown Prince attended the opening ceremony. Do you think his attendance created a good impression?

KO: I think that it is very important for the success of a meeting in Japan to have a member of the Imperial Family attend. Professor Sudao? was President of the ISN at that time and was very grateful that the attendance of the Japanese Crown Prince enhanced the meeting.

NS: Foreign guests were all impressed that the Crown Prince spoke fluent English at the opening ceremony.

KO: The Crown Prince is very intelligent and he is skilled in English because he studied overseas for a long time. I think that half the impetus leading to the success of the meeting was provided by the good impression made by the Crown Prince because of his good English.

Japanese Society of Nephrology:

NS: What made you become a specialist in nephrology?

KO: Before I studied nephrology, I studied hypertension. When I obtained my doctorate in 1938, I had spent two years in the library studying hypertension but there were no good papers. When I had given up hope, I found a 1937 Journal of Clinical Investigation displayed at the entrance of the library. When I looked at it I notice Goldblatt hypertension and the despair which I felt for two years disappeared. From 1938 I started studying Goldblatt hypertension and continued even during the War. After the War, I worked on the bioassay of renin for about three years. Bioassay of renin was impossible with the reagents available at that time. Therefore, I didnít obtain any results and I thought that I would stop being a researcher. However, I thought again that the relationship between renal function and hypertension might provide some kind of method for examining renal function and I returned to reading the older Y..............? Harding. In 1928, van Slyke? published a paper on urea clearance. Itís remarkable that no one had noticed it. But I was troubled by this paper and as a result, I started studying urea clearance. When I decided to do this and announced research on renal function using clearance in 1948, 1949 and 1950, people with the same idea gradually appeared when they heard this. The hypertension research group originally consisted of five or six investigators and we continued working on hypertension. I actually started to study nephrology when I moved to Nihon University in 1953. At that time, Dr. Hatano was in charge of renal morphology and Professor Sugino was in charge of function. We formed a nephrology group among the five or six groups formed at that time. We announced our results at around the end of the third day of the meeting of the Japanese Circulation Society. However, most of the audience had already left and we decided that a nephrology society should be formed. We discussed this at the chlorthiazide meeting held in Hong Kong in 1958. I decided this with Drs. Yoshitoshi, Waida? and Asino? and preparations for the formation of the Japanese Society of Nephrology started immediately after we returned to Japan. The Society was founded the next year in June 1959.

NS: When the Japanese Society of Nephrology was established many doctors were troubled because they had been members of the Japanese Circulation Society up to that time. Today, the Society has more than 5,000 members. You and the other three doctors have worked very hard.

KO: When the Society was formed, it was initially a research society and later became an academic society. The research society met about seven times. The greatest effort was required for publishing the journal since publishing two issues a year was considered appropriate, the journal was published first as a quarterly but we had to work hard to get the funds required and collect the manuscripts. Thanks to everyoneísí efforts, there are now 6,500 subscribers. When the first issue was published, we started with 60 subscribers and this has increased gradually every year. As a result, nephrology really became established in Japan and at present it has become a basis for expansion of hemodialysis. However, I sometimes think back on what would have happened to hemodialysis if there has been no nephrology.

Asian Pacific Congress of Nephrology:

NS: Another of your successes which should not be overlooked is the holding of the first Asia Pacific Congress of Nephrology in Tokyo. Please tell us about the background to that conference.

KO: Japan is located in the Far East. After the Japanese Society was established, the American Society of Nephrology became Pan-American, when the Congress was held in Mexico and included Latin America. In Europe there is a Transplantation and Dialysis Association and it hold a European Congress. Therefore, since Japan is located in the Far East, I thought it would be good to hold one congress in the Asian Pacific region toward the next century. I also thought that we could not delay much longer and we had to hold a congress in the Asian Pacific area as soon as possible. Therefore, I first visited Professor Kincaid-Smith of Melbourne and immediately gained her approval to hold an Asian Pacific Congress. thanks to those efforts the Asian Pacific Congress of Nephrology was held in the Tokyo Prince Hotel in 1979 and was highly evaluated by the participants. This was due to everyoneísí efforts. Various difficulties arose later but it has been held every three years since then. The Sixth Asian Pacific Congress was held in Hong Kong this year with about 800 participants.

NS: What were your impressions of these congresses?

KO: Well, in the beginning I was worried. But after three or four times, I thought that they would continued. I think that it is wonderful that this was the Sixth Asian Pacific Congress. Later I heard that they were thinking of an international Congress in Sydney the year after next and if this occurs these congresses will continued even more regularly.

Future Prospects of the ISN:

NS: The ISN has gradually increased in size and has reached 3000 or 4000 members. Young Japanese are gradually presenting more research results at international meetings and this is a very good thing. How do you think that these presentations are being received?

KO: Well, development of nephrology occurs directly as a result of research done by these investigators and since there are many nephrologists in the world, it is gratifying that such advances in nephrology have been made. It is very fortunate that this starting points has been established. This requires not only the development of Japanese nephrology but also progress in international nephrology and progress in Asian Pacific nephrology is also necessary. Researchers in the field of nephrology are well aware of the need for electrolytic equilibrium. In other words, to live in harmony. I am sure that the good relationship already established not only among researchers in their own countries but also among researchers internationally will continued to develop. I am very pleased to see this tend which will facilitate and contribute to progress in the area of nephrology.

NS: Thank you very much for this discussion.

Afterword by Dr. Kurokawa:

KK: Together with the late Professor Hamburger, Dr. Oshima was responsible for the creation of a new world of nephrology in 1960 when our Society was founded. Dr. Oshima has since then attended as a senior member of the Society all the Congresses of the Society up to the Jerusalem Congress in 1993. Unfortunately, he could not attend the Madrid Congress in 1995 due to unexpected illness. But in that Congress, Stewart Cameron, President of the Society, presented a special gift to Dr. Oshima in recognition of his contributions to our Society.

Location of ISN Congresses

Geneva/Evian 1960

Prague 1963

Washington DC 1966

Stockholm 1969

Mexico 1972

Florence 1975

Montreal 1978

Athens 1981

Los Angeles 1984

London 1987

Tokyo 1990

Jerusalem 1993

Madrid 1995