The long and rich tradition of Nephrology at the NYU School of Medicine can be traced back to Homer W. Smith, the most well known pioneer in renal physiology. Smith became the Chair in Physiology in 1928 and quickly established an important collaboration with William Goldring and Herbert Chasis, both members of the Department of Medicine. This was long before the recognition of Nephrology as a subspeciality; Goldring and Chasis’ interests were in hypertensive disease and the elucidation of the role of hemodynamic and renal electrolyte transport changes in the pathogenesis of hypertension. In an uninterrupted history, Domingo Gomez, David Baldwin, Francis Chinard, Philip Steinmetz, Lance Dworkin, Joel Neugarten and Jerome Lowenstein have continued this tradition of relying on physiologic measurements to better understand hypertensive and renal diseases in the Nephrology Division.
Lowenstein compared renal hemodynamics in normotensive subjects and patients with essential hypertension. Indicator dilution curves across the renal vascular bed revealed generalized vasoconstriction but no evidence of focal ischemia in hypertensives. Peritubular capillary pressure, as estimated from measurements of wedged renal vein pressure (WRVP) demonstrated an increase in intrarenal pressure in hypertensives, attributable to greater transmission of elevated arterial pressure beyond the glomerular arterioles. Exaggerated natriuresis in hypertensives was associated with a marked increase in WRVP. These findings led to the hypothesis that renal sodium excretion is governed by intrarenal pressure and that hypertension might serve to maintain sodium balance in conditions characterized by impaired sodium excretion.
In parallel with studies of the pathophysiology of hypertensive and renal diseases, the Nephrology Division, under the leadership of David Baldwin, has for more than forty years contributed seminal descriptions of the natural history of virtually all of the common forms of parenchymal renal disease. These include post-streptococcaal glomerulonephritis, membranous glomerulonephritis, crescentic glomerulonephritis, glomerulonephritis in infective endocarditis, allergic interstitial nephritis, IgA nephropathy, HIV nephropathy, lupus glomerulonephritis, minimal change nephrotic syndrome with renal failure, acute renal failure associated with cardiopulmonary bypass, contrast-induced nephropathy, remission of secondary amyloidosis, and renal disease associated with plasmacytic disorders.
The clinical descriptions of renal diseases benefited greatly from the fact that the patients were drawn from a single medical center and followed closely by our faculty and renal fellows. Equally, the Nephrology Division always collaborated closely with outstanding renal pathologists. Robert McCluskey worked closely with David Baldwin at a time when immunofluorescence microscopy presented new insights into the pathogenesis of renal diseases. Gloria Gallo, who followed McClusky, was a serious student of renal disease and herself an independent investigator of the nature of amyloid deposits in renal diseases. In the past several years, Laura Barisoni has established herself as a major pathologist in the emerging field of podocytopathies. This evolution fits very well with the focus of the Nephrology Division during the past decade.
Left to right: Herbert Chasis, MD, William Goldring, MD, and Homer Smith, MD, were part of the extraordinary team of researchers that translated basic science discoveries into clinical practice at NYU.