History of the Division

From left to right: Myles Wolf, M.D.; Peter Mundel, M.D.; David Roth, M.D.; Jochen Reiser, M.D, Ph.D; Arif Asif, M.D.; and Olver Lenz, M.D.

In the late 1950’s and early 1960’s the Department of Medicine had a Division of Metabolism whose chief was Dr. A. Gorman Hills, a renowned renal physiologist. The division was divided into two sections: Endocrinology and Nephrology. Dr. Joel Mann was the director of the Nephrology Division.

Dr. William H. Hulet joined the Department of Physiology in 1959. He was trained by the eminent physiologist Dr. Homer Smith and became particularly interested in the evolution of marine animal kidneys and the means by which they achieved environmental homeostasis. He founded the Section of Renal Physiology at the Coral Gables Veterans Administration Hospital where he was joined by Dr. John Richardson. This Section was large and well funded. It included numerous laboratories, electron microscopes, a dog laboratory, clinical procedure rooms and adequate office and conference space.

Chronic hemodialysis first became a reality in Miami in the fall of 1965 when Dr. William Way Anderson  started hemodialysis on a 15 year old boy with uremia. In preparation for initiating dialysis, Dr. Anderson spent a week in Seattle training in dialysis techniques with Dr. Belding Scribner at the Seattle Artificial Kidney Center.  It was the result of this first dialysis effort that led directly to the awarding of a large multiyear USPHS home dialysis contract to the University of Miami with Drs. Mann and Anderson as the Principal Investigators. This eventuated in the subsequent establishment of the South Florida Artificial Kidney Center.

In February 1966, Dr. Richardson opened the first hemodialysis unit in the state. This was a then state-of-the-art unit that evidenced the meticulous detail and caring that reflected Dr. Richardson’s personality. The dialyzers were of the now obsolete Kiill multiple plate/membrane type and were effective, although inefficient by today’s standards. Before long, the unit acquired ever more modern devices and either kept pace with or led this rapidly advancing field. Drs. Hulet and Richardson established a fellowship in nephrology in affiliation with the University of Miami. This was particularly attractive because of the robust patient population, immediate laboratory availability, access to the electron microscope and the fact that fellows were taught to perform renal biopsies, renal arteriograms and ureteral catheterization for separate renal function studies.

On July 1, 1967, Dr. Eliseo Perez-Stable was recruited from the University of Pittsburgh and the Pittsburgh VA Hospital.  Dr. Victoriano Pardo joined the group as an outstanding nephropatholgist and Dr. Barry Materson started as a Fellow in Nephrology. Drs. Perez-Stable and Materson established a relationship that prospered for more than 30 years.

The new Miami VA Medical Center opened in the UM/JMH Medical Center vicinity in March 1968 as a full affiliate of the University of Miami. The Renal Section was relocated to the 10^th floor and the various laboratories were relocated to a separate research building, 2^nd floor space and to Pathology. Dr. Hulet left in 1969 to pursue his interests in marine biology in which he ultimately earned a PhD. Drs. Richardson and Perez-Stable ran the Renal Section until Dr. Solomon Papper was recruited from the University of New Mexico. Dr. Papper was appointed Chief of Medicine and recruited Dr. Carlos Vaamonde and others to the Renal Section. Dr. Vaamonde directed a very productive Renal Section at the VA until his retirement in 2002, at which time Dr. Leopoldo Raij was recruited to assume leadership at the VA.. Dr. Murray Epstein was also recruited by  Drs. Harrington and Papper to join the Nephrology faculty in 1970. During his 39 years as a faculty member of the Division, he developed the water immersion model as a volume expansive research tool to delineate the determinants of volume homeostasis in both normal physiology and edematous disorders including decompensated liver disease. He was also a pioneer in defining the role of calcium antagonists in the treatment of hypertension and cardiovascular disease. In collaboration with Dr. Rodger Loutzenhiser, he developed the isolated perfused hydronephrotic kidney as an investigative tool to videomicroscopically define the renal microcirculatory effects of diverse drugs (calcium antagonists, angiotensin receptor blockers, DA1 agonists) and physiologic interventions on the afferent and efferent renal arterioles.

Dr. Papper left due to illness and Dr. Perez-Stable was promoted to Chief of Medicine and Professor of Medicine. Dr. Materson joined him as Associate Chief of MedicineIn the late 1970s, the eminent nephrologist Dr. Neal Bricker moved to the University of  Miami from the Albert Einstein College of Medicine to assume the position of Vice Chairman of Medicine. Several prominent renal investigators joined him including Drs. Leon Fine and Jacques Bourgoignie. Dr. Bourgoignie assumed the position of Chief of Nephrology at the Medical School. Originally a basic scientist with research interests in renal physiology, Dr. Bourgoignie later became a very productive clinical investigator and is credited with being one of the first to describe what was later called HIV Associated Nephropathy. He also brought several large NIH clinical trials to the University of Miami, including the Modification of Diet in Renal Disease Study and the African American Study of Kidney Disease. On his retirement as Division Chief in 2001, Dr. David Roth assumed leadership of the Division. He supervised a rapid expansion of the clinical services of the Division over the ensuing 7 years. During this time, the Division expanded it’s ESRD program to include four dialysis clinics and one of the largest peritoneal dialysis programs in the state. In addition, his vision was responsible for the development of the first ‘full-service’ academic Interventional Nephrology programs in the country.  During this time, he also helped secure several large philanthropic contributions to the Division that allowed for the  development of junior faculty into clinical and basic research scientists.

In February 2008, the new Chairman of Medicine, Dr. Marc E. Lippman, recruited Dr. Jochen Reiser from Harvard Medical School and the Massachusetts General Hospital to assume the position as Chief of the Division.  Since then, Dr. Reiser has recruited 15 additional faculty as well as close to 35 additional staff members to complement the existing Nephrology team members. With a wide diversity of strength reaching from excellence in clinical and basic research as well as Drug Discovery paired with an increasing demand of renal services that needed to be provided (newly acquired University Hospital, Jackson Memorial Hospital and the VA Hospital), Dr. Reiser created a novel administrative model of running an academic Nephrology Division. The Division was divided into Clinical Nephrology, Clinical Research, Interventional Nephrology, Basic Research as well as Drug Discovery. Each programmatic arm has distinct directorship (Dr. David Roth - Clinical Services, Dr. Oliver Lenz - Fellowship Program, Dr. Myles Wolf - Clinical Research, Dr. Arif Asif - Interventional Nephrology, Dr. Jochen Reiser - Basic and Translational Research, Dr. Jochen Reiser and Dr. Vineet Gupta - Drug Discovery ). Today, all programs are fully operational.