The University of Pennsylvania, over the last 250 years, has played an important national role in establishing new programs in medicine and biomedical science. Such was the case with nephrology when a program in renal medicine was established at the Hospital of the University of Pennsylvania in the days following World War II. Of course, the original thread of a renal discipline at Penn had its start much earlier. It began shortly after the turn of the century, when Alfred Newton Richards was appointed to the Department of Pharmacology and began to work on the physiology of urine formation. By the early-twenties, using micropuncture of renal tubules, he was one of the first to prove that glomeruli filtered plasma. Richards quickly emerged as one of the original investigative pioneers in renal physiology in this country, and he later held office as President of the National Academy of Science and Vice-Chancellor of the University.
During all this great excitement in the Department of Pharmacology, almost unnoticed, Dr. Merkel Jacobs, one of Richard's contemporaries, was appointed Professor of General Physiology in 1923. Dr. Jacobs was interested in diffusion and the transfer of ions across cell membranes, and he is remembered as the father of membrane transport. In 1926, one his students, Eugene Landis published his thesis work on micropuncture measurements of capillary pressure. After a successful career at Penn, he went on to direct the Marine Biological Laboratories at Woods Hole. During this same period, Dr. William Stadie came to Penn as the Musser Professor. In 1932, he and Dr. Helen O'Brien purified carbonic anhydrase and began studying its effects on the buffering capacity of blood. Later their findings would help explain bicarbonate reclamation along the proximal tubule. The advances derived from these early investigations made possible the conditions for realizing a future discipline of renal medicine at the University.
In a parallel area of medicine, during the Second World War, Dr. Balduin Lucké, Chairman of Pathology at Penn first described the pathological changes seen in kidneys associated with 'crush syndrome'. He named this condition lower nephron nephrosis, a term that later became acute tubular necrosis. In this same interval, Dr. Calvin F. Kay, an internist in the Maloney Medical Clinic at the Hospital of the University of Pennsylvania, began experimenting with the inflammation in kidneys produced following injection of anti-renal sera. In a series of careful, single-authored papers he first described the autologous phase of heterologous antibody-induced glomerulonephritis in rabbits.
In 1946, C. Mahlon Kline, a founding partner of Smith, Kline, and French, fell off his horse while riding on his Bryn Mawr farm and was taken to the Hospital of the University of Pennsylvania. He liked his care so much that he told his physician that he wanted to donate $25,000 to the University of Pennsylvania. Dr. Richards, then Vice-Chancellor of the University, gave Kline's donation to Francis Wood, the newly appointed Chief of Medicine who asked what he should do with it. Dr. Richards gave him two pieces of advice: one, "Don't hoard it" and, two, "Use it for something you think is really worthwhile." Dr. Wood convinced Dr. John Kapp Clark to leave the Schmidt laboratories in Pharmacology to start a Renal Section in the Gates Pavilion at the Hospital of the University of Pennsylvania. A year or so later at the annual Clinical Research Meetings in Atlantic City, Dr. J. Russell Elkinton (a student of Dr. John Peters at Yale and an early pioneer in the measurement of blood chemistries) mentioned to Dr. Wood that he also wished to return to his Philadelphia birthplace. Dr. Wood claimed, however, to not have a cent to pay him! The next year Dr. Elkinton said he was coming back to Philadelphia, even if he had to work for free. Dr. Wood then 'discovered some funds', and in 1948 Dr. Elkinton became the new Chief of the Chemical Section.
The Renal and Chemical Sections prospered greatly over the next twenty years. Dr. Elkinton, utilizing the principles taught him by Dr. Peters, developed a strong program aimed at producing physicians, scientists and scholars interested in careers in academic medicine in the areas of renal physiology, renal disease, and body fluid metabolism. Former faculty members and fellows of the program have gone on to be chiefs of Nephrology, chairs of Departments of Medicine, deans of medical schools and universities, and editors of prestigious medical journals.
Dr. Clyde Barker, former Chief of Surgery at Penn, established a highly successful kidney transplant program in 1966 that has since transplanted over 4000 renal allografts. In 1967, Dr. Wyngaarden, then Chairman of Medicine, had the presence of mind to join the Renal and Chemical Sections under one name. Dr. Martin Goldberg accepted Dr. Wyngaarden's offer of appointment to be the first Chief of the new Renal-Electrolyte Section.
Under Dr. Goldberg's direction the basic principles of the program remained unchanged, but the breadth and depth of the program was expanded by instituting new research techniques, like tubular perfusion and electron probe analysis, and by enlarging both the faculty and the pool of clinical patients available for study. Dr. Zalman Agus was appointed by Dr. Laurence E. Earley, another distinguished nephrologist who became the Chairman of Medicine in 1977, as the new Chief of the Renal-Electrolyte Section in 1979. Under Dr. Agus, the research program continued to enlarge with the addition of a renal immunobiology group, a renal microelectrode and patch-clamp laboratory, and a Stone Evaluation Center. This period of activity was characterized principally by a diversification and expansion of experimental interests within the Section.
In 1988 Dr. Agus returned to full-time bench research and Dr. Eric Neilson was appointed as the Chief of the Renal-Electrolyte Section. Dr. Stanley Goldfarb was appointed Co-Chief, as well as Director of the Clinical Research Center. Both Drs. Neilson and Goldfarb continued to expand Penn's investigative programs in kidney disease with new faculty recruitments who provided new, or extended areas of research, in autoimmune glomerulonephritis, extracellular matrix, renal epidemiology, and hypertension. This period of activity was characterized principally by a diversification and expansion of experimental interests within the Section. The Penn Center for the Treatment and Evaluation of Complex Hypertension was developed by Dr. Ray Townsend. Dr. Fuad Ziyadeh launched a successful research program in elucidating the pathogenesis of diabetic kidney disease and made significant contributions in this field. The Division opened its first out-patient dialysis unit at 42 nd and Walnut Streets under the direction of Dr. Alan Wasserstein who also began a Kidney Stone Evaluation Center that continues to this day. Dr. Bernard Kaplan, Professor and Chief of Pediatric Nephrology, strengthened the overall program by recruiting additional research faculty to the Department of Pediatrics at Children’s Hospital of Philadelphia. Faculty at CHOP are active participants in activities of the Renal-Electrolyte and Hypertension Division’s clinical, educational, and research activities.
In 1993, the Section was designated a George M. O'Brien Center for Urologic and Kidney Research by the NIH, and at the urging of Dr. Edward Holmes, then Chairman of Medicine, the Section changed its name to the Renal-Electrolyte and Hypertension Division in keeping with its expanded role in the School of Medicine.
In 1996 the second dialysis unit associated with Penn opened at Radnor, under the direction of Dr. Sidney Kobrin. In 1998, a section of the Renal-Electrolyte and Hypertension Division under the leadership of Dr. Michael Rudnick was established at what is now known as Penn Presbyterian Medical Center and the third Penn-affiliated chronic outpatient dialysis facility was opened at that hospital.
In 1998, Dr. Laurence Turka, who joined the faculty in 1993 with a joint appointment in the Institute for Human Gene Therapy and established a research program centered on investigation of the immunobiology of transplantation, was appointed the new Chief of Division. Dr. Michael Madaio was appointed Training Program Director. Over the next few years there was expansion of the core group of investigators pursuing clinical investigation in renal epidemiology under the leadership of Dr. Harold Feldman. Dr. Roy Bloom succeeded Dr. Robert Grossman, who had been Medical Director of Renal Transplantation, as Medical Director of Kidney and Pancreas Transplantation at HUP in 2001. In 2006 the fourth chronic dialysis associated with the Division was opened at 37 th and Market Streets.
In 2006, Dr. Turka was appointed to the highly prestigious position of Editor-in-Chief of the Journal of Clinical Investigation, and announced that he would be stepping down as Division Chief. Also in 2006, Dr. Jeffrey Berns was appointed as Director of Clinical Nephrology and Director of the Renal Fellowship Training Program for the Division. Dr. Berns served as Interim Chief of the Division from 2007 until October 2009 when Dr. Lawrence Holzman was appointed Chief of the Division. Dr. Holzman is a distinguished scientist with research interests in podocyte biology and glomerular diseases of the kidney, as well as a respected clinical doctor.
Thus, the Renal-Electrolyte and Hypertension Division today, in continuity with its past, seeks to preserve and perpetuate its academic mission to perform high quality biomedical research and to train young physician-scientists and clinicians. Our parallel endeavor has also been to prepare our faculty and trainees to eventually assume leadership positions in nephrology and its allied disciplines. Much has changed over the years leading to what the Renal-Electrolyte and Hypertension Division has become, and in future years we anticipate that there will be further exciting developments that will continue to maintain our Division as one that is widely recognized for its outstanding contributions to nephrology.