The University of Pennsylvania has a strong history of innovation in medicine. The first medical school in the United States was founded here in 1765 at the College of Philadelphia (now the University of Pennsylvania). Years later, a formal program in renal medicine was established following World War II at the Hospital of the University of Pennsylvania. In this section, we describe the origins of our Renal Division and a sampling of the leaders that shaped nephrology.
The Origins of a Renal Division at Penn (1900’s-1948)
Although our Division was formed shortly after World War II, the kidney discipline at Penn originated at the turn of the 20th century, when Dr. Alfred Newton Richards (Department of Pharmacology) began to study the physiology of urine formation. By the early 1920s, he used micropuncture of renal tubules to become one of the first to prove that the glomeruli make urine by filtering plasma. Dr. 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.
Simultaneously, in 1923, Dr. Merkel Jacobs was appointed Professor of General Physiology. Dr. Jacobs—remembered as the father of membrane transport—was interested in diffusion and the transfer of ions across cell membranes. In 1926, one of his students, Dr. Eugene Landis published his thesis 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—who came to Penn as the Musser Professor—and Dr. Helen O'Brien purified carbonic anhydrase in 1932 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 carved the path for 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 the 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, Mr. 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 Dr. Francis Wood, the newly appointed Chief of Medicine, along with two pieces of advice: one, "Don't hoard it" and, two, "Use it for something you think is really worthwhile." Dr. Wood used the funds to convince Dr. John Kapp Clark to leave the Schmidt laboratories in Pharmacology and 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 birthplace of Philadelphia. 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 at Penn (1948-1992): the predecessors of the Renal-Electrolyte and Hypertension Division
The Renal and Chemical Sections prospered greatly over the next twenty years. Dr. Elkinton 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. Several of his former faculty members and fellows 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.
In 1966, Dr. Clyde Barker, former Chief of Surgery at Penn, established a highly successful kidney transplant program that has since transplanted over 4000 renal allografts.
In 1967, Dr. Wyngaarden, then Chairman of Medicine, sought 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. The section grew to include several leaders in nephrology, including Dr. Samuel O. Thier, a leader in health policy who went on to become the President of the Institute of Medicine and the first President of Partners HealthCare.
The late 1960’s also features some of the first women leaders in nephrology, including Dr. Donna McCurdy and Dr. Patricia Gabow. Dr. McCurdy was the first recorded women nephrologist at the University of Pennsylvania. She was a medical educator, leader, and fierce advocate for women in medicine. Dr. McCurdy inspired several generations of women leaders, including Dr. Patricia Gabow – a national leader in delivery system innovation and a thought leader focused on serving the underserved. Dr. Gabow, who was one of the first women medical students and nephrology fellows at the University of Pennsylvania, speaks of that time fondly. In a 2006 Penn Medicine article, Dr. Gabow noted: “My life has really been a series of wonderful mentors,” and that “Dr. McCurdy was a wonderful teacher and one of the very few female faculty members at the time. When working in nephrology with her, I decided that that was for me.”
She was also the first ‘out’ LGBTQ+ faculty member within the Division, which is particularly notable since her time at Penn preceded the Stonewall Riots in the 1960s, when homosexuality was considered pathological. She was publicly out to her fellow faculty members, including Dr. Thier, who supported Dr. McCurdy and her partner through her final days (she died in her 40’s from metastatic breast cancer). She is recognized at Penn through the Donna McCurdy Housestaff Teaching award and the McCurdy Conference Room within the Renal Division.
In 1979, Dr. Zalman Agus was appointed as the new Chief of the Renal-Electrolyte Section by Dr. Laurence E. Earley (another distinguished nephrologist who became the Chairman of Medicine in 1977). 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. Eric Neilson was appointed as the Chief of the Renal-Electrolyte Section as Dr. Agus returned to full-time bench research. He 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 investigating the pathogenesis of diabetic kidney disease. The Division opened its first outpatient dialysis unit at 42nd and Walnut Streets under the direction of Dr. Alan Wasserstein, who also began the Kidney Stone Evaluation Center that continues to this day. Dr. Bernard Kaplan, Professor and Chief of Pediatric Nephrology, strengthened the nephrology program by recruiting additional research faculty to the Department of Pediatrics at Children's Hospital of Philadelphia (CHOP). Faculty at CHOP are active participants in activities of the Renal-Electrolyte and Hypertension Division's clinical, educational, and research activities.
The Early Years of the Renal-Electrolyte and Hypertension Division at Penn (1993-2009)
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 the Division and 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. In 2001, 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 2006 the fourth chronic dialysis unit associated with the Division was opened at 37th 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. That year, Dr. Jeffrey Berns was appointed as Director of Clinical Nephrology and Director of the Nephrology 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 clinician, who continues to lead the Division and our fellowship alongside Dr. Amanda Leonberg-Yoo, the current program director.
Today, the Division maintains a continuity with its past with the goal 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 where we are now, 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.
To read more about our current initiatives and leaders, please peruse the rest of our website, including:
- A message from the Chief
- A message from the Program Director
- Messages from our Director and Chief Fellow for Diversity, Equity, and Inclusion
- An overview of research initiatives within our Division
Notes:
- The History of Nephrology page was last revised on 10/05/2022 by Dr. Yuvaram Reddy, Dr. Amanda Leonberg-Yoo, and Dr. Rachel Hilburg.
- Pictures were reproduced with permission from Dr. Eric G. Neilson