Prof. Vincenzo Cambi (1937-2020)
In memory of Vincenzo Cambi (1937-2020)
Prof. Vincenzo Cambi was an important clinical physician who had a very solid scientific basis and preparation. He was an innovator in the field of renal dialysis and a milestone within the Italian and international field of nephrology.
He was born in 1937 in Varese (Italy) in the region of Lombardy. He received his medical degree from the University of Parma (Italy). In 1969 he attended courses in renal diseases at the University of Seattle, Washingon, (U.S.A.) as a senior fellow. Prof. B.H. Scribner was the head of the department which, at that time, was at the forefront in renal dialysis research. It was in Seattle that dialysis was being used not only in cases of acute kidney insufficiency, but also for patients who had a chronic renal failure. Prof. Scribner had invented a reusable vascular artero-venous shunt, allowing to perform regular dialysis sessions. In Seattle Cambi joined a group of young doctors who would become the great forerunners in this field: H. Tenckhoff, J.W. Eschbach, G. Stricker. This group was close to Prof. Scribner, attracted by his ingenious talent for experimentation, his charism and his captivating lectures. Prof. Scribner’s quality which had most impressed Cambi was his human empathy and determination and dedication to save, through dialysis, patients who would have otherwise been doomed.
Cambi returned to Parma (Italy) as an Associate Professor fortified with the same determination and convictions he had inherited in the United States. In 1972 he became Assistant Director in the Department directed by Prof. Migone, a great leader and master of Italian nephrology.
Prof. Cambi was aware of the problems his patients had to face and his priority was finding a way to help them. He had the great intuition of reducing the dialysis from 8-12 hours a week to 4 hours three times a week or 3 hours every other day. His “Short Dialysis” was developed in Italy and during the seventies it became the standard treatment model. The benefits of this were recognized and are associated with an enhanced physical and psychological patient wellbeing. Furthermore, with this system it became possible to save the lives of more patients using the few existing dialysis centers. Prof. Cambi was very proud of this accomplishment.
In 1980 Cambi became a full professor of Nephrology and Director of the of Nephrology Dialysis unit and of the post graduate school of Nephrology at the University of Parma. He also initiated a program of kidney transplantation and was creator of the internationally well known “Parma Nephrology School”.
Cambi’s students remember him as being a very strict and demanding professor who was however capable of generating enthusiasm among the young thanks to his innovative teaching methods based on interactive discussions. He kept abreast of and shared the newly published literature in the field which at that time was not easily accessible and which, furthermore, was jealously guarded as an instrument of power by those who were less illuminated then him. During the eighties, together with the leading Italian nephrologists Cambi was a co-author to the Italian Dialysis Manual, aimed at making the clinical aspects of dialysis better known and better understood also by those who were less familiar with the more technical and complex issues. This treaty underwent many revisions and reprints and for years was a reference point for a whole generation of nephrologists.
His presentations at national and international conferences were clear and scientifically sound, never banal. He didn’t hesitate to express his views enthusiastically and with scientific rigor even when they conflicted with those of others. These controversies livened up many conferences and are still remembered by those who attended. In 1990 he was elected Secretary-Treasurer of the ERA-EDTA, in which he had already been an ordinary Council member.
The 1991 the annual society meeting was scheduled to be held in Belgrade and because of the unforeseen outbreak of the war in Yugoslavia it could not be held there. Prof. Cambi came up with unexpected organizational and managerial abilities and, at the very last minute, saved the conference by transferring it to Rimini (Italy). Notwithstanding the loss of nonrefundable deposits, as President of the Congress, he managed to put together a very successful meeting, both scientifically and economically. Superfluous and intermediary expenses were eliminated as he strategically and wisely managed the society’s funds, reorganized the structure of the society and created an ethically transparent congress office which was entrusted with managing the Society’s increased resources. Resources which allowed the Society to invest in scientific and educational programs benefitting those members who lived in countries with limited resources. The scientific prestige of the Society’s conferences was heightened and thanks to the choice of qualified Editors-in-Chief of NDT (the Society’s official journal) so also was the quality of the journal.
The title of Chairperson of the Administrative Offices was offered to him in recognition of his dedication to the Society. He was nominated as Chairperson of the Administrative Offices and later was confirmed as an Honorary Member of the Society.
In his private life, Prof. Cambi was reserved and was a man of few words, as are many scientists. He firmly believed in friendship and enjoyed entertaining his friends and colleagues at his country house in the hills surrounding Parma. There he personally prepared refined and original meals for his guests.
He loved beautiful things which he, together with his wife, Graziella who was always at his side, searched for in art, music and literature.
He was an avid sportsman: mountain climbing and skiing were among his favorites as were tennis and fitness exercises. As in his work, he set high and ambitious goals for himself, pushing himself to the limit.
He will be remembered as being an enthusiastic person who was continuously striving to attain and achieve those noble qualities inherent in a man of science.
By Salvatore David (translated by Angela Casella)
Dr. Norman K. Hollenberg (1936-2020)
Obituary for Norman K. Hollenberg, M.D., PhD. (1936-2020)
by Prof. Murray Epstein
Figure 1. Norman Hollenberg in his laboratory, circa 1974
Figure 2. Norman Hollenberg as we would wish to remember him, with fellow members of the WRAP (Worldwide Renal Advisory Panel) Advisory. The photo was taken at the last (10th) meeting of WRAP in 2006 in San Francisco. Front row, left to right: Dick de Zeeuw of Holland, Sheldon Tobe of Canada, Hans-Henrik Parving of Denmark, Mark Cooper of Australia, Vito Campese of United States, Murray Epstein, Chair of the WRAP Committee, Mathieu Ghadenfar of Pfizer, Jan Buch the Danish Cardiologist who advised the WRAP members, and Milton Pressler of Pfizer. Second Row, left to right: Larry Hunsicker of the United States, Vincent Esnault of France, Josep Redon of Spain, and to the extreme right of the photo Dr. Norman Hollenberg with his classic “Norm smile”. The woman in front was Dr Jill Spiegel, the Pfizer Medical Expert for Renal. This photo is reproduced with permission from Dr. Mathieu Ghadenfar.
Norman K. Hollenberg, M.D., Ph.D., renowned leader in cardiovascular medicine and hypertension, passed away on January 15th, 2020, after a long illness. He spent his entire academic career at the Brigham and Women’s Hospital, the institution he loved for 50 years. Dr. Hollenberg was Professor of Medicine and Radiology and Director of Research in Radiology at the Brigham and Women’s Hospital and Harvard Medical School. He leaves a remarkable lasting legacy in nephrology and hypertension and in medicine broadly.
Dr. Hollenberg was born in Winnipeg, Manitoba. He earned his undergraduate and medical degrees at the University of Manitoba. His Ph.D. in Pharmacology was obtained under Professor Börje Uvnäs at the Karolinska Institute in Stockholm, Sweden and Professor Mark Nickerson at the University of Manitoba and later at McGill University in Canada.
After a medical residency in Winnipeg, Norm completed his nephrology fellowship in the Cardiorenal Unit of the Peter Bent Brigham Hospital in Boston, under the tutelage of John Merrill, M.D., one of the renowned founders of modern nephrology (1). Uvnäs, Nickerson and Merrill all had an enormous influence on his approach to biology and medicine, his value system, and his dedication to academic pursuits, but I believe that Mark Nickerson and the heady and exciting academic environment in the Pharmacology Department at the University of Manitoba had the most profound impact in nurturing Norm’s scientific discipline and thirst for knowledge.
I (ME) first met Norm when I arrived at the Peter Bent Brigham in July of 1966 to start my nephrology fellowship. Our Chief, John Merrill, tasked Norm to “bring me up to speed”. I collaborated with Norm in his early studies of intrarenal hemodynamics in both healthy individuals and those with a wide array of diseases (2, 3, and 4). Our initial studies utilizing the companion modalities of selective renal arteriography and 133 xenon washout curves succeeded in demonstrating that a redistribution of intrarenal perfusion with resultant cortical ischemia mediated acute renal failure (2).
We subsequently succeeded in extending this investigative approach to studying patients with Hepatorenal Syndrome and demonstrated a preferential reduction in renal cortical perfusion (4). In addition cirrhotic patients manifested marked vasomotor instability. There was a profound, and indeed striking disparity between the absence of vascular filling of the cortical vessels pre=mortem, and subsequent postmortem angiography in the same patients. Postmortem angiography performed on the kidneys of 5 patients studied during life disclosed a striking complete normalization of the vascular abnormalities. In concert these studies provided compelling evidence for the functional basis of the renal failure of patients with decompensated cirrhosis.
Of note, the above cited studies in acute renal failure and Hepatorenal Syndrome loomed importantly in resolving one of the important and dominant controversies in renal physiology
In the 1950’s; the Josep Trueta vs. Homer Smith controversy focusing on the importance of renal cortical perfusion (5). In 1947, Trueta and collaborators at the Nuffield Infirmary at Oxford University published a book, “Studies of the Renal Circulation”, summarizing the large body of evidence from their studies. They proposed that the kidney had two circulatory beds, a major or cortical circulation and a central or medullary circulation. In contrast to the general receptivity of Trueta’s book outside the assembly of physiologists and nephrologists at large, his studies of the renal circulation were not well received by many traditional and established physiologists in the United States, where it was repudiated by some physiologists, most notably the reigning expert of renal physiology, Homer Smith. Twenty three years later Norm Hollenberg and Murray Epstein succeeded in proving the “nay sayers” wrong, and validated the Trueta hypothesis. Our xenon washout and selective renal arteriographic studies in patients with acute renal failure of diverse etiology, consistently demonstrated the absence of an early rapid component, indicating prevailing renal cortical ischemia (2, 4). In concert our ﬁndings resolved the conflict in favor of Trueta, and provided strong support to the formulation that preferential diffuse cortical ischemia was present in all patients with ARF of diverse etiology.
Norm and I became not only research collaborators, but virtual brothers, frequently traveling worldwide to attend medical congresses, and sharing life cycle events. He lovingly counseled me with advice, garbed as parables and anecdotes.
From its beginning, Dr. Hollenberg’s career focused on the kidney. Over his academic career exceeding 50 years of extensive and groundbreaking research solidified his position as one of the true giants in the regulation of the renal circulation in health and disease. Norm’s research productivity was enormous and he authored more than 600 publications. His many accomplishments included documenting the factors (both hormonal and environmental) that control the renal circulation, and delineation of the mechanisms whereby these mediators modulate renal function in order to subserve sodium homeostasis. Concomitantly he assessed how defects and dysfunction and dysregulation promote the development of hypertension, diabetic nephropathy and congestive heart failure (6). Much of his research was the product of decades-long collaboration with his close friend, Dr. Gordon Williams, who is a Professor of Medicine at Harvard Medical School and the Brigham and Women’s Hospital.
It should be underscored in many ways that Norm’s outlook and investigative approach was Eurocentric. He contributed to the training and development of several European nephrologists and hypertension experts who later on, became highly recognized and respected leaders in the International Society of nephrology (ISN), the European Society of Hypertension and International Society of Hypertension (ISH). Among them, one can cite Professor Albert Mimran one of Norm’s earliest research fellows who worked with Norm between 1970 and 1972, before returning to Montpellier, France to head the Department of Nephrology. Professor Mimran was elected president of the ISH in 2002. Peter De Leeuw, Professor of Medicine at Maastricht University, also trained with Dr Hollenberg between 1979 and 1981. Influenced by their mentor’s enthusiasm, both Albert and Peter successfully pursued their clinical and experimental research on the role of the kidney and the renal vasculature in the development of several forms of hypertension, mainly renovascular hypertension. Norm had a warm and productive collaboration with Professor Mattias Aurell, Professor at the Sahlgrenska Hospital and the University of Gothenburg, and one of the world leaders in defining the pivotal relationship between the renin-angiotensin system and both hypertension, and progressive chronic kidney disease.
Dr. Hollenberg’s contributions to the current treatment paradigms for the management of hypertension were profound. He was a pioneer in the development of new therapeutic agents that modulated the renin-angiotensin system, and their application in the treatment of a wide array of diseases in order to attenuate, abrogate and even reverse many cardiovascular and renal disorders. He was the first to investigate the impact of blocking the renin-angiotensin system on renal function and hormonal systems. He conducted elegant physiological experiments in humans with ACE inhibitors, angiotensin receptor antagonists and ultimately renin inhibitors. Using these drug classes as pharmacological probes to interfere with the regulation of renal hemodynamics and sodium transport, his work has increased markedly our understanding of renal physiology in the context of hypertension. He was also among the first investigator to administer an ACE inhibitor to a patient with congestive heart failure, at a time when the prevailing wisdom asserted that this new drug would be fatal. The patient recovered and was able to ambulate and ultimately be discharged to return home.
As a consequence of his insights and formidable clinical investigations, Dr. Hollenberg’s research catalyzed the development of two important classes of drugs, ACE inhibitors and angiotensin receptor blockers. Today they are prescribed to millions of patients for the treatment of hypertension, congestive heart failure and chronic kidney disease, particularly in patients with diabetes mellitus.
More recently Dr. Hollenberg’s research interests focused on the vascular effects of flavonoid-rich cocoa(7). Of note, cocoa is the richest known source of flavanols. These studies married medical anthropology and the important arena of vascular responsiveness (7). A true medical detective – Dr. Hollenberg was intrigued by the low blood pressures of the Kuna Amerinds of the San Blas islands of Panama and posed an obvious question; was the absence of hypertension attributable to protective genes or environmental factors. Consequently, Hollenberg and colleagues initiated a comprehensive study of the Kuna Amerinds that provided the link to our understanding of this clinical observation, increased oxidative stress and impaired nitric oxide bioavailability to be the principal features of vascular dysfunction, detectable as abnormal coronary vasomotion (7). Based on Dr. Hollenberg’s seminal research, two decades ago, a large clinical trial is underway to determine whether flavanoids found in chocolate may confer health benefits, including lowering blood pressure and the risk for cardiovascular disease COSMOS- (The COcoa Supplement and Multivitamin Outcomes Study).
One of my most enjoyable, fulfilling and substantive joint endeavors for one of us (ME) with Norm was our participation in the Worldwide Renal Advisory Panel (WRAP). In 1996, I was invited by Pfizer Pharmaceuticals to organize a worldwide renal advisory board composed of fifteen leading nephrologists; four from the United States and Canada and one each from each of the major European countries, Australia and Japan. (Figure 2). Of interest to the readership and members of ERA/EDTA, half the committee was comprised by renowned experts from Europe. Our deliberations focused on two disease states – hypertension and chronic kidney disease. The subsequent decade of biannual meetings was a heady and exciting period resulting in the initiation and conduct of many projects, research endeavors and ultimately contributed importantly to updating and revising the treatment paradigm for controlling hypertension.
Beyond research, Dr. Hollenberg had a special interest in medical education and teaching. Norm’s door was always open in welcome. Over the decades, he mentored countless students and fellows, many of whom became professors and leaders in their communities around the world. He served as one of four Associate Editors at the New England Journal of Medicine for seventeen years. He also served on the editorial boards of a dozen journals, as the Editor of the Atlas of Hypertension and Editor-In-Chief of Current Hypertension Reports.
The world of medicine and the nephrology and hypertension communities in particular, have lost one of its true giants. Norman Hollenberg was truly one of the great leaders in renal medicine and hypertension. As was apparent to all who were privileged to know Norm, he was witty and exceptionally eloquent, a consummate storyteller. Importantly, the world has lost a kind, caring and gentle person and a true gentleman.
Norman Hollenberg is survived by his daughter Ilana Hollenberg, his son David Hollenberg, and his beloved and loving wife of 35 years, Deborah, who stayed close by his side, caring for him with all her love and strength until he left us.
The authors thank Dr. David L. Epstein for his thoughtful assistance and suggestions in the preparation of this manuscript.
1. Epstein M. John P. Merrill: the father of nephrology as a specialty. Clin J Am Soc Nephrol. 2009 Jan; 4(1):2-8.
2. Hollenberg NK, Epstein M, Basch RI, Oken DE, Merrill JP. Acute oliguric renal failure in man: evidence for preferential renal cortical ischemia. Medicine 47:455-474, 1968.
3. Hollenberg NK, Epstein M, Basch RI, Merrill JP. “No man’s land” of the renal vasculature: an arteriographic and hemodynamic assessment of the interlobar and arcuate arteries in essential and accelerated hypertension. Am J Med. 47:845-854, 1969.
4. Epstein M, Berk DP, Hollenberg NK, Adams DF, Chalmers TC, Abrams HL, Merrill JP. Renal failure in the patient with cirrhosis; the role of active vasoconstriction. Am J Med. 49:175-184, 1970.
5. Epstein M, Eknoyan G. A forgotten chapter in the history of the renal circulation: the Josep Trueta and Homer Smith intellectual conflict. Am J Physiol Renal Physiol. 2015; 309(2):F90-7.
6. Hollenberg NK, Moore T, Shoback D, Redgrave J Rabinowe S, Williams GH. Abnormal renal sodium handling in essential hypertension: Relation to failure of renal and adrenal modulation of responses to angiotensin II. Amer J Med 81: 412-418, 1986.
7. Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. 2003; 21(12):2281-6.
Address for correspondence
Murray Epstein, MD, FASN
Division of Nephrology and Hypertension
P.O. Box 016960 (R126)
Miami, FL 33101
Phone: (305) 479-7201
Dr. med. Rolfdieter Krause (1945-2019)
We are sad to announce that
EURORECKD has lost one of its founding members
Dr. med. Rolfdieter Krause
born on 2 November 1945, died on 28 June 2019 in Berlin.
Rolfdieter Krause started his career as a doctor of Sports Medicine and served as physician for the German rowing team for many years. He became a nephrologist and integrated his knowledge of Sports Medicine with the needs of patients with chronic kidney disease. He was a pioneer in exercise training and physical rehabilitation for patients on dialysis. Throughout his career he was dedicated to further this cause in Germany, by creating ReNi and internationally by creating the EURORECKD.
He was General Secretary of the EURORECKD since the beginning and was instrumental in creating a platform for EURORECKD’s activities in close cooperation with the ERA-EDTA. Rolfdieter Krause was involved and active within the organisation throughout his life and helped plan the activities for the 2019 ERA-EDTA congress in Budapest.
We are truly grateful for his enthusiasm, dedication and for all the time he gave EURORECKD. We have lost a dear friend and colleague. Our thoughts go to his dear wife Christiane, who often joined him on his trips to the ERA-EDTA and EURORECKD activities, and their son Christian.
for the EURORECKD council, July 6, 2019
Naomi Clyne Adamasco Cupisti Evelyn Kouidi Asterios Deligiannis
Chairman Vice-chairman Vice-chairman Treasurer
Prof. Claude Jacobs (1932-2019)
In memoriam : Professor Claude JACOBS (1932-2019)
On April 2, Professor Claude JACOBS passed away at the end of a cruel illness that he faced with as much courage as lucidity.
Born in Strasbourg, he experienced during his teenage years the worst, as he sometimes confided. It is to the courage and generosity of a family of farmers that he owes his survival under the Occupation, hidden in Auvergne for more than 2 years. Back in Paris, his studies were outstanding, interrupted by a 30-month stay in Algeria where he served France in a particularly high-risk region.
Upon his return, the Resident of the Paris hospitals discovered the nascent intensive cares in Nephrology, and especially the possibilities offered by peritoneal dialysis in patients suffering from acute renal failure, thanks to his mentor, Professor Marcel LEGRAIN who became his dear friend. Claude then understood, one of the very first in France, that Belding SCRIBNER at the Washington University in Seattle has just opened up the wide field of dialysis treatment of end-stage chronic uremia. Thanks to a WHO grant, he went to Seattle for three months and came back to France to meet again Marcel LEGRAIN who had created a Nephrology Department at the Hospital Foch in the Paris suburbs to open the second hemodialysis center in France. Together with Marcel LEGRAIN and René KUSS, he performed one of the first kidney allografts in this hospital.
Appointed Professor at the University Paris 6, he became Medical Director of the hospital Pasteur Vallery-Radot at AURA-Paris, a non-profit association founded by Professor Jean HAMBURGER to make dialysis treatments accessible to the greatest number of people. In 1987, he joined the Pitié-Salpétrière University Hospital in Paris as head of the nephrology department where he became interested in many areas of nephrology : pharmacology, hemodialysis and peritoneal dialysis (particularly in diabetic patients), kidney transplantation and simultaneous pancreas-kidney transplantation.
At the same time, Claude JACOBS was actively involved in the international nephrology community. Long a representative of France on the ERA-EDTA Registry Committee, he had the great honour of organizing and chairing the 29th Congress of this association in Paris in 1992. It was a wonderful scientific meeting and a very user-friendly experience.
Because he was gifted with a remarkable analytical and synthesizing mind, and in addition multilingual, his interventions were highly sought-after. Loving travel and tireless, he could not count his journeys, willingly admitting the pleasure that human relations throughout the world gave him.
Claude JACOBS also liked writing. He has extensively published and participated on Editorial Boards of prestigious journals, including NDT and AJKD. And who did not appreciate many times the reading of the famous textbook “Replacement of renal function by dialysis” of which he was one of the main co-authors.
Claude only had friends. Welcoming, always available, confident, he never let go of his warm smile. He was also a man with firm convictions. He was able to defend them without ever abandoning his calm and with respect for his interlocutors, whoever they may be.
The last years have been overshadowed by the long illness of his wife Jeanine, whom he cared for at home until the end. Our thoughts go out to his children Frédéric, MD in intensive care unit, and Valérie who surrounded him with affectionate delicacy. We assure them that Claude will not be forgotten.
Françoise MIGNON Thierry PETITCLERC
Professor emeritus of Nephrology at University Paris-7 Medical advisor at AURA-Paris
Prof. Francois Berthoux (1942-2019)
Obituary for Professor François Berthoux (born on January 19, 1942 – died on February 6, 2019) – by Prof. Christophe Mariat.
“…. I have, by now, lived with this disease for more than half a century, and for more than a quarter century I have had end-stage kidney failure, undergoing dialysis and then a transplant. From the beginning, I knew it was going to be a real battle, and so I went about finding the best way to put up a decent fight. Indeed, I decided to meet this disease on its own terms… I sometimes even think that having faced such an adversity has provided me with strength more than it has been a curse…”.
This interview excerpt which was included in a book entitled: “D’autres reins que les miens” (“Other kidneys, but not mine”), highlights the difficulty encountered by one of his Fellows in recounting the professional career of Professor François BERTHOUX, given that his career is closely and tightly intertwined with his life.
Professor François BERTHOUX’s career is very much part of the history of Nephrology. Indeed, leafing through the book on his professional life is equivalent to perusing the first book on Nephrology, for which the introductory chapters were written by Gabriel RICHET, Jean HAMBURGER, and Jules TRAEGER. François BERTHOUX joined his unit at the Antiquaille Hospital in Lyon in 1964. This was a time when everything still had to be invented for this still emerging medical specialty and when all of the innovative ideas of these brazen pioneers (e.g., the first dialysis, the development of the first treatments against transplant rejection, the foundations of medical intensive care) were turned into seminal advances in Nephrology. Jules TRAEGER, François BERTHOUX’s mentor, admired him very much and often, with a certain degree of malice, confided that, out of all of his fellows, had ultimately been his favorite.
In 1971-1972, the American adventure began in Boston in the unit of, once again another legend in the field, John MERRIL, a visionary figure and the founder of Nephrology in the United States where, in 1954, the first kidney transplant took place, which proved to be an unabated success. After this particular period, François BERTHOUX developed an unwavering fascination for medical research in the United States and in the country as a whole.
Back in France, François BERTHOUX based himself at Saint-Etienne, where dialysis, transplantation, intensive care, anatomical pathology, functional explorations, and research still needed to be established. In essence, he created a unit based on what his mentor, Jules TRAEGER, taught him and keeping in mind his aspirations.
When we think about François Berthoux the two main traits that shine through are his qualities as a “builder” and his qualities as a Visionary man.
As a “builder”, he went against all odds when he decided to spearhead the kidney transplant programme in Saint-Etienne, by engaging the services of a young surgeon from Lyon who had just been exposed to the basics of transplantation surgery in the unit run by Professor Jean-Michel DUBERNARD. This young surgeon, who went on to become one of the most illustrious authorities in Vascular Surgery worldwide and locally became the exponent of transplantation surgery accepted this kind offer, perhaps as a result of the residency lectures given by François BERTHOUX, but more likely because of his strong wish to tackle the challenges of human existence. In 1979, Xavier BARRAL and François BERTHOUX performed the first kidney transplantation at the CHU of Saint-Etienne, without fanfare and nearly in secret. According to the journal LE PROGRES, it is said that the hospital administration did not hear about the transplant until the day after the procedure.
A builder also of a Nephrology School which soon became world renowned, built around the fight of his life, namely IgA nephropathy. For years, at international nephrology conferences, the three most cited cities in France were Paris, Tassin (with the Artificial Renal Center created by Guy LAURENT another “defector” of the TRAEGER dynasty)), and Saint-Etienne.
Lastly, he was a “builder”, in the real meaning of the word, when he created the ARTIC 42 dialysis association that he founded and presided over. A bona fide SME that meant a lot to him, especially because his main goal was to provide a service to patients and also because it allowed him to use his entrepreneurial skills and to carry out his “Big Projects”. One of his most recent projects was the first ultra-low energy passive dialysis facility in Europe, a revolutionary concept, which has proven to be the swan song of this visionary man.
Back in the 1970s he had a vision of the importance of thinking in terms of patient populations in an era when nephrology was still based on the onerous description of individual cases. This intuition came to fruition thanks to a methodological and nearly monastic compilation of clinical data, the collection of sera and genetic material that he pursued incessantly throughout his career and that, more than 40 years later, has become one of the most extensive patient cohorts ever assembled for IgA nephropathy.
He was also considered a visionary, in an era when the medical and scientific world in France was enthralled by the United States, when he decided, despite his affinity with the US, to focus on Europe. Several years later he became the President of ERA-EDTA and, among other contributions, chaired the very first European Guidelines for Best Practice in kidney transplantation.
Lastly, he was a visionary thanks to his ability to embrace scientific, medical, and technical advances while also refraining from the pseudo-modern trend of hyper-specialising medicine and moving away from bedside practice. According to him, nephrology was above all a clinical specialty, with a multitude of aspects, a specialty that had to resist attempts at “Balkanization” between the proponents of nephrology as internal medicine, the proponents of dialysis, and the proponents of transplantation.
For us, François BERTHOUX’s legacy is boundless, first of all in material terms but even more so at a spiritual level, in both the secular and the generic sense of the term. It involves a mindset, an expectation of excellence, an affinity for innovation, curiosity, and open-mindedness, as well as renunciation and resilience for the sake of the patient receiving treatment and care.
Today, our prayers and heartfelt thoughts, go to his children: Emilie, Nicolas, Christophe and their spouses; to his numerous grandchildren and particularly to Patricia, who has been an extraordinary wife to an exceptional man.
Prof. Miroslav Mydlik (1932-2018)
Professor Miroslav Mydlik (Košice 1932-2018) – The scientist, the teacher and the man
1Natale G De Santo, and 2Katka Derzsiova
1 Emeritus Professor Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
2 Engineer, Former Head of the Nephrological Laboratory at the 1st and 4th Internal Clinic of the University Hospital of L. Pasteur and Medical Faculty of P.J. Šafárik University in Košice , Slovak Republic
Miroslav Mydlik, MD, DSc (Fìgure 1) was born on July 21, 1932 in Košice (at that time in Czechoslovakia), where he died on September 6, 2018 as Slovak citizen.
After completing the high school in Košice, in 1951 he started medical studies and successfully graduated at the Faculty of Medicine of the Charles University Prague, in 1957.
After graduation he began working as a house physician at the Department for Infectious Diseases at the Faculty Hospital of Regional Institute of National Health (KUNZ) in Košice. From August 1st, 1959 until December 10th, 1959 he worked as a general practitioner in Biel. From December 11th, 1959 he was a house physician at the Internal Clinic of Faculty Hospital KUNZ in Košice.
He successfully passed the attestation of 1st degree in internal medicine in 1961 and of 2nd degree in internal medicine in 1964. From January 1st, 1964 to July 1st, 1979 he worked as an assistant professor at the 1st Department of Internal Medicine, Medical Faculty of P.J. Šafárik University. In the years 1972–1975 he has been leading teacher of undergraduate students of Medical Faculty of P.J. Šafárik University. In 1971 he successfully defended his PhD thesis in clinical nephrology and in 1973 he passed a follow-up specialization in nephrology, being the first in Slovakia. From 1979 to April 1st, 1992 he worked as a registrar for nephrology and, at the same time, he was the Head of Dialysis Centre of the 4th Internal Clinic at the Faculty Hospital with Polyclinic, and later at the Faculty Hospital of L. Pasteur.
The enlightening training with Jan Brod in Prague in 1963
Miroslav Mydlik in 1963 was for 4 months (January-April) postgraduate scientist at the Institute for Cardiovascular Research in Prague (Czechoslovakia), headed by Jan Brod ( 1). Professor Brod at that time was a world star in nephrology and was organizing the International Congress which took place in Prague that year. It was a fruitful stay since Brod gave a lot of time to students and fellows. Of those days Miroslav Mydlik wrote “My postgraduate stay consisted of: a) work at clinical department; b) in nephrological outpatients department together with Prof. Brod one day a week; c) participation in seminars; d) active participation in scientific and research project on the measurement of blood pressure by direct and indirect method. Later the results of this project were published. The obtained results were: the values of systolic blood pressure which were measured by direct method were 1.33 – 1.86 kPa higher than the values measured by indirect method. In examination of diastolic blood pressure the values which were found during the direct measurement of blood pressure corresponded to the values which were measured by indirect method in sudden weakness of sounds. In disappearance of sounds the values of diastolic blood pressure measured by indirect method were lower in comparison with the values which were measured by direct method” (1). The findings of that studies were published in 1966 (2). In Prague Mydlik learned kidney biopsy procedures under the supervision of Professor Brod, which were immediately adopted in Košice (3).
The road to Professor of Medicine
In 1984 he successfully defended his academic title of “Doctor of Medical Sciences“ at the Medical Faculty of Charles University in Prague and in 1990 he habilitated as Associate Professor of Internal Medicine. In 1992 he was finally appointed by President Václav Havel full Professor of Internal Medicine.
In January 1966 Miroslav Mydlik was a founder of a dialysis centre at the 1st Internal Clinic and organized a splendid laboratory for nephrology, initially at the 1st Internal Clinic and later at the 4th Internal Clinic. As chief for that laboratory, in 1969 enrolled for a life position Eng. Katka Derzsiova. She renovated the laboratory and introduced new techniques and equipment to study metabolic changes in chronic renal failure and during dialysis, mainly metabolism of vitamins and hemoperfusion through active charcoal and other sorbents. This was an epochal change which reflected on the number and quality of the scientific production. This coincided with a creative and fertile period in the career of Professor Mydlik. It also happened that the Lady Engineer was turned into a brilliant investigator in the field of nephrology, uremia toxicity and dialysis, and hemoperfusion. Many new projects were started, various grants were obtained.
In the years 1970-1990 he enhanced and shifted the centre to a qualitatively higher level at the 1st and later at the 4th Internal Clinic of Faculty Hospital of L. Pasteur. In 1963 he performed the first percutaneous renal biopsy and in 1977 he carried out the first hemoperfusion through active charcoal in the patient suffering from paraquat poisoning, that was the first in the former Czechoslovakia. Moreover he gradually introduced all the extracorporeal elimination methods and CAPD which are still used in the dialysis centres (1-4).
Publications and presentations
The list of Mydlik’s works includes over 450 scientific publications, comprising original articles in national and international journals, editorials, and chapters in books. Main topics were Metabolic changes in chronic renal failure, Metabolic disorders of some vitamins in chronic renal failure, Renal replacement therapy, Uremic toxins, Hemoperfusion in acute poisoning in vivo and in vitro. He was a presenter (over 785 presentations) in domestic and international congresses in Europe, USA, South America, Asia. He also organized many nephrological congresses and symposiums in Czechoslovakia, Slovakia, most of them with international participation (1970-2012).
Prof. Mydlik was initiator of awarding the honorary title of Doctor Honoris Causa of P.J. Šafárik University in Košice. In the years 1993-2006 the title was awarded to various outstanding scientists including 7 professors of nephrology (Shaul Massry, Joel Kopple, Horst Klinkmann, Franciszek Kokot, Natale G De Santo, Guido Bellinghieri and Vittorio Bonomini).
Professor M. Mydlik, as the former Head of Dialysis unit (1966-1992) of the 4th Internal Clinic (1992–1997) and the Nephrological Clinic (1997-2003) of the Medical School of P.J. Šafarik University and University Hospital of L. Pasteur in Košice, made significant clinical experiences with 1,300 patients, who underwent renal biopsy, with 1,500 patients undergoing renal replacement therapy and with 380 patients with acute poisonings.
Professor Mydlik was Head of the Subchair of Nephrology and Dialysis of Postgraduate School of Medicine in Bratislava ( 1991-2003); President of the Medical Association in Košice (1990-2002); Prorector of the P.J. Šafárik University in Košice (1994–1997); Main specialist for nephrology of the Ministry of Health, Slovak Republic (1994-2007); Member of the board of Slovak Nephrological Society (1969-2007); Member of the Council (2011-2016) of International Association for the History of Nephrology (4-7).
The last years
After retirement he continued to work (up to December 2017) one day a week for an internal nephrological outpatient ambulance at the 4th Internal Clinic, University Hospital of L. Pasteur and at the Institute of Experimental Medicine, Medical School of P.J. Šafárik University. He also continued to give lectures for Slovak and foreign university medical students.
In September 2016 Professor Mydlik was instrumental for the foundation of the European Association of Professors Emeriti (EAPE) in Athens, where he gave an enthusiastic talk and was elected in the Council at Large of the newly founded association. However in December 2017 he declined the possibility of re-election.
The last international talk was given at Wloclawek in Poland, at the 2017 Congress of the International Association for the History of Nephrology (IAHN). The last talks in Slovakia were given in November 2017. At the Meeting on Preventive medicine he spoke about Renal Disease and Aging. At the Franz Kafka Medical and Literary Memorial in Kežmarok, there was a ceremony for the release of the book of Miroslav Mydlik and Katka Derzsiova entitled Lung Tuberculosis of Franz Kafka. The influence of Disease on His Literary Work. For that book events were planned at the P.J. Śafárik University in Košice and at the Franz Kafka Center in Prague. But they could not take place. Professor Mydlik was diagnosed myastenia gravis and underwent successful treatment at the hospital of his university. He recovered but in January 2018 for a spine problem surgery was needed. There were various complications. Health suddenly deteriorated and he needed long lasting hospitalization at the Geriatric Center of the St. Lukas Hospital. However his spirit was strong and was still developing new plans. However the disease prevailed. On September 6, 2018 he died. His funeral took place on the subsequent day, people of the University, University Hospital and patients participated in the event. There were many outstanding talks from prominent speakers. He was buried at the Rozalia Cemetery in Košice.
He was Honorary Member of the Polish Society of Nephrology (1994), Honorary Member of Slovak (1997) and Czech Medical Society (2002), and correspondent Member of the Russian Academy of Medical Sciences.
Miroslav Mydlik was Visiting Professor at the Faculty of Medicine of Bruxelles (Belgium), at the Nephrological Clinic of the Medical University in Katowice (Poland) following invitation of Professor Franciszek Kokot and the Moscow Institute of Medicine of the Academy of URSS at invitation of Professor Irina J. Tareieva.
Miroslav Mydlik was awarded the Purkyně Medal of Czechoslovak Medical Society (1979); The International Distinguished Medal of the National Kidney Foundation (USA), (1994); The Medal of the University of Messina, Italy (2000); The Medal “Sigillo Magno“ of the University of Bologna (2002); The Medal “Golden Kidney“ of the Slovak Nephrological Society (2002); Professor Emeritus of P.J. Šafárik University, Košice (2004); The Medal of Campania Sicily Branch of the Italian Society Branch of Nephrology; the Teofil Rudolf Niederland Price—the highest honor conferred by the Slovak Medical Society—awarded by the Presidium of Slovak Medical Society, as the highest prize to a top specialist (only one scientist per year) for long-term significant scientific and professional activities in the field of medicine and pharmacy (Bratislava, 2009); the Gold Medal of P.J. Šafárik University, Košice (2009); “The Lifelong Contribution Award for Medical and Biological Sciences” awarded by the Board of the Literary Fund of the Slovak Republic (2014); On December 8th, 2015 he was introduced into the “Hall of Glory of Slovak Medicine” in Bratislava.
The many cultural interests of Miroslv Mydlik
He was interested in world literature, theatre, classical music, history of Egypt, Greece and Italy and history of medicine. He founded the Franz Kafka Monument in Tatranské Matliare (High Tatras) in 2001, and was the organizer of 8 International medical and literary symposiums dedicated to Franz Kafka in the years 2001-2014. In association with J. Vajó he was the editor of a significant book. Edit. P. J. Šafárik University, in Košice 2013 (469 pages). He was also a co-author of the first Slovak monograph in nephrology: Dzúrik R., Šašinka M., Mydlík M., Kovács L., et al. Nephrology. Bratislava, Herba comp. Ltd. 2004 (877 pages).
His difficulties with the Communist Party
Miroslav Mydlik was a liberal in the classical sense greatly influenced by the history of Košice, his birth place. He never registered in the Czechoslovak Communist party which was compulsory to make a career in a state position. He did not accept the suggestion even when he was promised a career in the Academy. During the Communist regime, he was even afraid to send his work to foreign journals. To avoid any inconvenience, he used to post them from Hungary, from the small border town of Sátoraljaújhely.
Indeed when he handed his habilitation work to the Scientific Council for university (circa 1979-1980), the Scientific Council locked it into a safe. He was informally told that until the members of the Communist Party had a role in the Scientific Council, he would not be promoted associate professor of internal medicine. However, after the revolution, from 1990 his work was fully recognized. Natale De Santo and Katka Derzsiova had occasion to visit the small Hungarian town with him. He said “here I could breathe liberty, and get an injection of hope for better times”.
The Medal of the council of the Faculty of Medicine of UPJŠ
On September 27, 2018, at the Meeting of the Scientific Council of the Faculty of Medicine of UPJŠ, on the occasion of the 70th anniversary of its foundation, Professor Miroslav Mydlik was awarded a medal in memoriam. The celebration took place in the House of Arts, in the concert hall of the Košice Philharmonic Orchestra. The medal was received by Eng. Katka Derzsiova (Figure 2).
His late fellows
It would be impossible to reconstruct now a complete list of the fellows of Miroslav Mydlik. We will list here only late fellows since we know he had a strong link with them. We list (i) Peter Mizla, MD, Director of the private dialysis Center Logman, ltd. in Košice; (ii) Professor Oliver Rácz, PhD, former head of the Institute of Pathophysiology, Medical Faculty of UPJŠ; (iii) Dipl. Ing. Michal Farkaš, former head of the biochemical laboratory in Trebišov, and a member of the Accreditation Commission for Biochemistry in Bratislava; (iv) Alojz Bomba, MVDr, Doctor of Veterinary Medicine, DrSc, head of the Institute of Experimental Medicine, Medical Faculty of UPJŠ; (v) RNDr. Anna Chmelárová, PhD, Scientific worker at the Institute of Experimental Medicine, Medical Faculty of UPJŠ ; (vi) Associate Professor Ľubomír Legáth, MD, PhD, head of the Department of Occupational Medicine, Medical Faculty of UPJŠ, Košice; (vii) Associate Professor Katka Šebeková, MD, DrSc, Medical School of Commenius University in Bratislava; and (viii)Professor Viera Spustová, MD, DSc. and President of the Slovak Society of Nephrology Bratislava.
The friend has gone
Professor Miroslav Mydlik was first of all a friend. His death is before all the death of friend. Here we wish to pay tribute to him adopting the words of Jean Guitton, the most important Catholic philosopher of last century in France: “The death of a friend generates a great vacuum. It is not just the vacuum of absentia which is irreparable too. It generates the feeling that part of ourselves lacks now approval, reflex, echo, and criticism. John’s Gospel renders in a simple and sublime way the distress of a person which is conscious that a fragment of his life is now settled in the past, because the friend has gone. One might say the whole gospel derives from this transformation of the time, which just for the departure of a friend is turned in a time past, an old testament. I have experienced on many occasions the inexorable death of part of myself due to the death of another person” (8).
- Mydlík M. Jan Brod and his contributions to hypertension and nephrology. J Nephrol 2011; 24(S17):S73-S76.
- Ulrych M, Burianová B, Hornych A, Mydlík M, Douša T, Hejl Z. Comparison of direct and indirect methods of measurement of arterial blood pressure in man. Cor Vasa 1966; 8: 77-88.
- Mydlík M and Dersziová K. The 50-year history of the Nephrology Department in Košice (Slovak Republic). J Nephrol 2006; 19 (suppl 10):S173-s178.
- Derzsiová K, Spustová V. Profesor MUDr. Miroslav Mydlík, DrSc., sedemdesiatpäťročný./ Professor Miroslav Mydlík, MD, DSc., seventy-five-year-old. Vnitř Lék 2007; 53 (7-8): 866-868.
- Mydlík M, Derzsiová K. 50-ročná publikačná činnosť v časopise Vnitřní Lékařství./50-year publishing activity in the journal Vnitřní Lékařství. Vnitř Lék 2012; 58: 76-79.
- Spustová V. Prof. MUDr. Miroslav Mydlík, DrSc. – Editoriál./ Professor Miroslav Mydlík, MD, DSc. – Editorial. Lek Obz 2017; 66 (6):199.
- Derzsiová K, Spustová V. Významné životné jubileum profesora MUDr. Miroslava Mydlíka, DrSc./ Important life jubilee of Professor Miroslav Mydlík, MD, DSc.Vnitř Lék 2012; 58(7 a8): 8-11.
- Guitton J. Paul VI secret. Desclée De Bouwer, Paris, 1971, p.7.
Figure 1: Professor Miroslav Mydlik (1932-2018)
Figure 2: Eng. Katka Derzsiova receives The Commemorative Medal of the Medical Faculty of UPJŠ on the occasion of the 70th anniversary of its foundation, awarded in memoriam to Professor Miroslav Mydlik by Dean of the Medical Faculty
Prof. Dr. Beat von Albertini (1944-2018)
A few weeks ago, Prof. Dr. Beat von Albertini passed away in Lausanne, Switzerland. He was 73 years-old. We would like to address Dr von Albertini’s pioneering contribution to the current knowledge of modern haemodialysis.
Dr von Albertini was a Swiss nephrologist born in Zurich who graduated as a medical doctor at the Faculty of Medicine of his city. He subsequently worked in the USA, initially as a resident in New York City, then at Stanford University where he reached the position of associate professor in nephrology, and finally in Washington D.C. In the seventies, with some colleagues from the George Washington University Medical Centre, he was the first to raise the concept of high efficiency dialysis, with the ultimate challenge to reduce dialysis duration to less than 3 hours, even 2 hours, three times-a-week. This involved the prescription of very high blood and dialysate flows, the use of larger needles, of dialyzers, or even double dialyzers with greater surface area and permeability, and the development of technologies to ensure volumetric control of the dialysate. This resulted in very high diffusive and convective transfer of uraemic toxins, ultimately permitting drastic reductions in treatment time over conventional dialysis, without sacrificing treatment adequacy.
When he returned in Switzerland in 1996, Prof. von Albertini treated all his dialysis patients in this way at the Clinic Cecil in Lausanne, strongly challenging the standard of dialysis care at that time, not only in Lausanne but also in Switzerland and Europe. His belief was that the patients should enjoy most of their time off dialysis. Nowadays, in modern dialysis, high blood and dialysate flows have become standard practice. In addition to his outstanding skills in dialysis science, the man Beat von Albertini was a special figure with a very strong personality. He could not attend a meeting without challenging the speakers with critical and always knowledgeable comments. He was loved by his patients and supported them constantly when they were in difficulty. He had passion, generosity, and vision. However, his personality was further magnified when he discussed culture, art, history and finance issues with an exceptional expertise. His overall impressive knowledge and his way of interacting with colleagues, friends and persons from all over the world made him a unique figure who will leave unforgettable memories in the mind of several generations of nephrologists.
Beat, we will miss you a lot.
Prof. Daniel Teta, Service de Néphrologie, Centre Hospitalier du Valais Romand, Hôpital de Sion, 1951 Sion, Switzerland (firstname.lastname@example.org)
Prof. Michel Burnier, Service de Néphrologie Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland (email@example.com)
Dr. Anne Cherpillod Grau, nephrologist, Centre de dialyse, Hirslanden Clinique Cecil, 1003 Lausanne, Switzerland (Anne.CherpillodGrau@hirslanden.ch)
Dr. Guy Laurent (1935-2018)
Dr Guy Laurent passed away a few days ago in his home of Tassin, France. He was 83 yo. Dr Laurent has been a pioneer of chronic hemodialysis therapy in France in the early sixties. He was the founder of the Tassin dialysis unit in 1969 where he and his colleagues treated patients with long-hour dialysis 3×8 hours per week with normal blood pressure without drugs and very good survival rate published in Charra et al (KI 1992). His experience has triggered the thoughts about dialysis time and frequency to improve the high death rate among dialysis patients. He was very close to patients, always looking to relieve them from the ESKD burden. He pushed them to go for home dialysis; he pushed them to go back to work. In the sixties many companies refused to readmit or employ dialysis patients. Dr Laurent founded the Société Materiels Annexes de Dialyse (SMAD) where dialysis patients were employed to produce shunts and tubings for their own therapy. This company has thrived and has now more than 600 employees. When the first dialysis patients he had treated in the sixties lost their autonomy he created a nursing home for them. Low salt diet, strict volume control, good nutrition, fistulas built by the nephrologists, dialysis time and holistic management of the patients were the pillars of his concept of dialysis adequacy. Dr Guy Laurent was a generous man who always welcome warmly the visitors in the Tassin unit. In 1991, considering that dialysis therapy was marginalised in nephrology meetings, he created the Société Francophone de Dialyse. This controversial initiative has efficiently contributed to bring back dialysis therapy in the main topics of national meetings and in research projects. We loose an exceptional figure of our community.
Charles Chazot, MD, NephroCare Tassin-Charcot, 7 Avenue Foch, 69110 Sainte Foy les Lyon, France
Guillaume Jean, MD, NephroCare Tassin-Charcot, 7 Avenue Foch, 69110 Sainte Foy les Lyon, France
Dr. Babu Shersad (1963-2017)
The Brightest Stars Burn Quickest
We are deeply saddened with the untimely death of Dr. Babu Shersad at the age of 54 due to cardiac arrest. Dr. Shersad was a veteran nephrologist and internal medicine specialist, who had supervised and conducted over 100,000 dialysis sessions over a 25-year career spanning 5 countries. At the time of his demise, he was Group Medical Director at AMSA Renal Care, which operates from multiple international locations.
Dr. Shersad completed his fellowship in Nephrology from the University of Chicago under the renowned Prof. Frederick Coe, and was also recognized as a special candidate for ‘Superior Performance’ by the American Board of Internal Medicine during his residency in Internal Medicine at Wayne State University, Detroit. His prior medical training was from his home country of India, at Kasturba Medical College (where he topped the MD examination in in 1990) and at JIPMER (MBBS). He was also a Fellow of the Royal College of Physicians and Surgeons of Glasgow.
During his career in Dubai, Dr. Shersad is well-known in the medical field for starting the first private dialysis centre in the nation while he served as the Medical Director of Welcare Hospital. He also started the first ever standalone dialysis center in the country, for which he tailored the protocols at international standards to maintain zero mortality. He was also the founder of the First Medical Center, known for its warm ambience and artistic interior decor.
Dr. Shersad was hailed for his humanitarian services of treating the poor and needy in several countries. One of his notable contributions was to create a culture of philanthropy in medical practice. He often rendered his services freely, and even mobilized resources to fund the treatment of hundreds of patients. As a vocal advocate for altruism in the medical practice, he often delivered speeches to medical professionals and students at various platforms in Dubai and India. He was also a regular voice in leading newspapers in Dubai on subjects of healthcare, and contributed to several community outreach programs. For the impact he created in the field of healthcare, he won many awards such as the “Professional Achiever of the Year” award in 2013 from Ahlan Masala (ITP media group), the “MediBiz TV Special Award” and the “Middle East Healthcare Leadership Award 2016”.
In his personal life, Dr. Shersad had a passion for collecting rare stamps, currency, and first edition books. He also led an active lifestyle as a hobbyist yoga practitioner, boxer, and cyclist. He lived his life based on the principles of compassion, generosity and optimism and could always be relied upon to provide words of wisdom to those in need of support. His life will continue to inspire many more in the years to come. Dr. Shersad is survived by his loving wife, Dr. Fouzia; children, Sumaiyya, Suhail and Safeer; sister, Sabeena; and both parents, Abubaker and Mumtaz, all of whom grieve his irreplaceable loss alongside countless patients, colleagues, friends, and professors.
Prof. Quirino Maggiore (1933-2017)
Professor Quirino Maggiore passed away on September 2nd, 2017. He was my master and mentor and I owe him the passion for clinical care and research and the attention to social and ethical aspects inherent to the medical profession. He was a great physician, a curious, creative investigator, an inspiring educator and a just man.
Professor Maggiore was an all-round internist and a formidable diagnostician. With him leading, the discussion of clinical cases at the bedside or during clinical meetings was a rigorous intellectual exercise that required 360 degree assessment of possible alternative hypotheses. In the 1970s, the science of clinical diagnosis was still at an early phase of development. Yet, he did not leave anything to approximation and simplistic deductions. His diagnostic exercise was intrinsically Bayesian and he discouraged superficial application of prêt-à-porter algorithms which he felt simplistic in most cases. His insight into suspecting the disease was formidable. I remember several cases in which, without any positive evidence of the disease he suspected, his acuity and ability to contextualize clinical data led him to bring forward definitive diagnostic tests that might have seemed unjustified by available clinical data.
Beyond the academic context in Pisa where he was educated, his methodological formation was Anglo-Saxon. He absorbed modern clinical methodology mostly during a fellowship in London at the Royal Free Hospital Liver Unit then led by Dame Sheila Sherlock. There he met Stanley Shaldon, who inspired him on the application of home haemodialysis. Shaldon also became his role-model for a frank approach to the scientific debate. Professor Maggiore’s interventions at meetings and congresses were always punctual, acute and, whenever he perceived the necessity, unconditionally critical but always respectful of the interlocutor. As a clinical investigator he was gifted with great creativity. His interests were vast and spanned from immunopathology to dialysis technology. The intuition to apply a hypothermic stimulus to increase vascular stability during dialysis, or plasma cooling in the extracorporeal circuit for the removal of immune complexes in cryoglobulinemia and the very formulation of the low protein diet remain among the most innovative advancements in the first three decades of the history of modern nephrology.
Professor Maggiore was uncompromising in situations where he felt that the protection of the most serious and fragile patients was not properly guaranteed. In the early 1980s, he resigned from the direction of a prestigious nephrology unit of a large academic hospital that was being developed because it was unacceptable to him that the managerial and the academic leadership of the same hospital had not placed the organization of an emergency department as an absolute priority. He was a great raconteur and listening to his narratives of places and people within and outside academia was an engaging and fascinating experience. He has maintained a solid and warm relationship with his staff over the years. Far beyond the professional context, among the ethics he transmitted to his colleagues and fellows, I believe that the human respect and the intellectual and moral honesty are the most notable ones. By his example, he made clear that apologizing when wrong is an imperative both in the professional and in the everyday life. In the mid-1970s, when Italian medicine was still ossified in baron-like professional relationships, he did not hesitate to apologize to his young collaborators even for minor dissonances.
Professor Quirino Maggiore is part of the noblest history of modern nephrology. He will be missed by his beloved wife Marta and by his children Elena, Giulia and Umberto and other family members and by the nephrology community at large.
Prof. Carmine Zoccali
The Masters of Nephrology: Interview with Quirino Maggiore
Prof. Fred Boen (1927-2017)
February 22th 2017 Fred Boen passed away. He was an icon in the field of peritoneal dialysis.
S.T. (Fred) Boen was born in Indonesia in 1927 and studied medicine in Djakarta, Indonesia, until 1949 when he and his wife moved to The Netherlands. He continued his study at the University of Amsterdam and wrote his PhD thesis ‘Peritoneal Dialysis, A clinical study of factors governing its effectiveness’ during his fellowship internal medicine at the Binnengasthuis which was a university hospital in Amsterdam, under supervision of Prof. Dr. JGG Borst. This thesis, published in 1959 and consisting of 166 pages, has become the standard on peritoneal dialysis (PD) in the beginning of the sixties. It includes an extensive review of the literature on PD from 1877 to 1958 covering experimental data on normal and uremic animals as well as early experiments with peritoneal dialysis in patients in chapter 1. Chapter 2 comprises an analysis of the kinetics of intermittent PD from data in patients with acute renal failure. These were modelled to diffusion curves for several solutes. At the end of this chapter he made a comparison between PD and extracorporeal dialysis with the artificial kidney and concluded that no essential differences between both modalities existed for diffusion of solutes. The management of acute renal failure, either conservatively or by dialysis is discussed in chapter 3. It includes the technique, difficulties and complications, and indications for PD. Case histories of 22 severely ill patients with acute renal failure treated by this new procedure are described in chapter 4, illustrated by pictures presenting the course of the disease during the PD treatment. Nine of the 22 survived.
The content of the thesis was published in Medicine in 1961, promoting PD as a relatively simple and effective procedure to treat patients with kidney failure, even for chronic dialysis. As a result of this paper Dr. Belding Scribner invited Fred Boen to the North West Kidney Center in Seattle and offered him the possibility to continue his research. Boen accepted this invitation and moved with his wife and children to Seattle in 1962 where he worked until 1965, setting up a program for chronic PD at home. In 1964 he edited a book on PD, entitled Peritoneal Dialysis in Clinical Medicine, the first and only book on PD at that time. After the introduction of Continuous Ambulatory Peritoneal Dialysis (CAPD) in 1976 by Popovich and Moncrief, Boen stimulated CAPD in the Netherlands and was involved in the first Dutch publication on PD.
Fred Boen was also active in international societies. He was elected as the first vice-president of the newly formed International Society for Peritoneal Dialysis in 1984. From 1979 until 1984 he was secretary-treasurer of the European Renal Association – Dialysis and Transplant Association (ERA-EDTA) and became an honorary member of this Association in 1988. In 1991 Fred Boen received the Special Recognition Award in Peritoneal Dialysis at the Annual Dialysis Co nference in Nashville. He received the ‘Celebration of Excellence’ from the North West Kidney Foundation in 1996. In the same year, Fred was honoured with the James W Haviland award for outstanding Achievement in Nephrology, for which he was commended by Bill Clinton, at the time president of the U.S.A.
50 year after he finished his PhD Thesis, this event was celebrated with a special article in Peritoneal Dialysis International in 2009. Fred Boen was very pleased with this publication, but at that time his medical situation had begun to deteriorate. He suffered from heart problems, a cerebral vascular accident and passed away in February, nearly 90 year old. We will remember him as a kind and dedicated person and one of the founding fathers of PD.
Elisabeth W Boeschoten
Raymond T Krediet
Previously published in Perit Dial Int 2017;37:356-357. The authors thank Perit Dial Int and Multimed Inc. for their permission to publish the obituary on the ERA-EDTA website.
Prof. Bruno Watschinger (1920-2017)
In memoriam – Prof. Bruno Watschinger, 1920-2017
On June 28, 2017, Professor Bruno Watschinger passed away at his home in Linz, Austria, 2 weeks after his 97th birthday. The Austrian Society of Nephrology is mourning not only its founder and president of many years, but also an internationally known visionary colleague, who always considered problems and borders as challenges, rather than as insurmountable barriers.
Bruno Watschinger was born on June 14, 1920 in Linz Austria. During the second world war he studied Medicine in Vienna and in Prague, where he received his doctor´s degree from the Karls-University. Following his internship in small hospitals in Upper Austria he moved to the University of Vienna. During a two-year-research fellowship (1948-1950) at the Department of Pharmacology he was particularly interested in studying renal clearances in a rat model of experimental hypertension. Later at the Department of Medicine he focused on human studies in fluid and electrolyte, as well as hypertension research.
In 1955, supported by a 3-month WHO stipend, he pursued a post doctoral fellowship at the Cleveland Clinic, USA working with Dr. Irvine Page and Dr. Arthur Corcoran, two well known experts in hypertension and last but not least with Dr. Willem Kolff, who in 1945 was first to successfully treat acute renal failure by means of dialysis, using his „Rotating Drum Artificial Kidney“ and who was leading the recently established worldwide first Department of Artificial Organs. Being asked by Kolff to do blood clotting studies during treatments with the rotating drum kidney, he refused as he did not see a chance to bring this complicated and expensive method back to the poor post-war Austria. He agreed, however to Kolff´s reply to his refusal – „So then, let us build an artificial kidney that is easy to use“. Together with Kolff he constructed the „Twin-Coil kidney“, an easy to use and inexpensive device, which for many years to follow, together with other types of dialyzers, facilitated the treatment for acute renal failure throughout the world and in later days, together with the development of permanent vascular accesses allowed the start of chronic dialysis in many places worldwide. The Twin-Coil also gave rise to dialysis production companies, a totally new industrial branch.
Picture shows Bruno Watschinger prepapring the twin coil for clinical use (1958)
After leaving the University of Vienna in 1960 he became Head of a Department of Internal Medicine at the Elisabethinen Hospital in Linz, where he found a supportive environment to follow his vision and to build up a dialysis unit, which soon became the biggest in Austria. In 1974 expanded the treatment options for kidney patients at the hospital by initiating the now third largest transplant program in Austria
Bruno Watschinger was co-founder of the Society of Nephrology of Germany, Switzerland and Austria in 1961, and founded the Austrian Society of Nephrology in 1970.
He remained tireless in promoting the goal for a better treatment for renal patients and to reach out to others in order to achieve this goal together. He considered it incomprehensible and inacceptable that during the cold war, when the „iron curtain“ was dividing Europe in East and West, colleagues from the former Eastern European countries were excluded from scientific exchange with the West. This triggered his founding of the Danube Symposia of Nephrology. Already in 1976, owing to his personality and helped by the political neutrality of Austria, he was successful to invite colleagues from the East to attend the first Danube Symposium in Linz, Austria. This successful start was followed by many subsequent meetings alternating between western and eastern Danube countries. The whole Danube Symposium initiative is still considered by many as a crucial support for nephrological science in their home countries at the time.
Bruno Watschinger was an enthusiastic scientist and doctor, who cared about his patients, he was a teacher, mentor for many generations of nephrologists. He was awarded Honorary President of the Austrian Society of Nephrology and has received honors from nephrological societies of many countries.
Bruno had a long association with the EDTA being one of its very early members and by contributing much, particularly to many of the annual congresses. He served as Congress President in 1973 and again in 1990 when the annual meetings were held in Vienna. In recognition of the outstanding support he gave to the ERA-EDTA he was awarded Honorary Membership in 1991. The Vienna congresses are remembered for the way in which Bruno was able to construct a programme which contained outstanding scientific merit (Proc EDTA 10, 1973 and Nephrol Dial Trans 1990; 5: 637-760) but, in addition, encompassed a social element so that friends and colleagues could meet, relax and renew friendships. Who cannot remember the 1990 Vienna meeting without thinking about the social programme which involved a train to Gumpoldskirchen and the subsequent happy hours in the Heurigens. Bruno Watschinger delivered congresses which fulfilled all that is required to ensure complete satisfaction for those attending.
In addition to his many academic achievements Bruno was a warm and kind person. He supported many in their early academic years and was unstinting in his encouragement of young researchers. He had a delightful sense of humour and always seemed to be smiling as illustrated by the photograph above. He had a great love for his wife and family and this was a significant support to him in his latter years. He was delighted that his son, Bruno, followed him in nephrology practice.
Bruno was a unique character who will be fondly remembered by all those with whom he came in contact whether as patients, colleagues, scientific co-workers or friends – they all seemed to end up becoming his friend. His contribution to medicine and nephrology in particular will be long remembered. The ERA-EDTA has lost a true friend and a valued supporter.
Rainer Oberbauer and Alexander M. Davison
Prof. Lee W. Henderson (1930-2017)
In Memoriam – Prof. Lee W. Henderson (1930-2017)
Lee W Henderson, MD, FACP, 86, died July 3 2017 at his home in Bellevue, Washington, USA. Born in New York in 1930, his remarkable career spanned the entire era of maintenance dialysis. He was a pioneer in research on peritoneal dialysis and hemodialysis during the 1960s and 1970s. His signature contribution to nephrology is his development of hemofiltration. His legacy includes leadership for many years of Baxter´s Extramural Grant Program (aka Renal Discoveries) – the largest research program in the world devoted to save and sustain lives of patients with kidney disease.
After medical studies at Harvard 1949-53, and continued education and residency at University of Pennsylvania and Pennsylvania Hospital, Philadelphia 1953-61, Dr Henderson moved to Peter Bent Brigham Hospital, Boston, Massachusetts. There he trained as Fellow, Renal Disease 1961-63 with Dr John P. Merrill (pioneer in dialysis and kidney transplantation, and by many considered to be the Father of Nephrology as a Specialty) (1, 2). At the age of 31 years, he published his first papers (with JP Merrill) on peritoneal dialysis in New England Journal of Medicine and Transactions American Society of Artificial Intern Organs, a leading journal in dialysis development at that time.
After moving back to University of Pennsylvania renal division, Philadelphia in 1963 as junior faculty member and later Associate Professor of Medicine, his research 1963-1974 focused among others on convective transport (1, 2). After a sabbatical at Scripps Clinic and Research Foundation, La Jolla, California, he moved west to the attractive climate at University of California, San Diego where served as Professor of Medicine 1975-1988 and in parallel Visiting Investigator, Scripps Clinic and Research Foundation. During this period, he published several seminal papers on hemofiltration and dialysis (1).
He would probably have remained in California had he not been headhunted for the position as Vice President, Scientific Affairs, Baxter, Chicago, Illinois where he worked 1988-2000 (plus 2004-05). His move to Chicago was in large part due to the unique opportunity to start (in 1989), and for many years lead, the Extramural Grant Program (later called Renal Discoveries), the largest research program in the world dedicated to save and sustain lives of patients with kidney disease. This provided much needed research money at a time when funding from the NIH, especially for chronic renal failure and dialysis research, was restricted. Hundreds of translational research projects involving hundreds (and indirectly probably thousands) of young and senior investigators in more than 20 countries received support. The investigators presented results of their research at annual meetings and in more than 1000 scientific papers in leading international journals, including NDT. The success of the program hinged substantially on Henderson’s insight, creativity, leadership, and knowledge of the field, personnel, and academic environment (1). Realizing the value of close collaborations between academia, clinical medicine and industry, Lee Henderson initiated also other extramural research activities such as the foundation in 1993 of Baxter Novum, Karolinska Institutet, Stockholm, Sweden.
After his retirement, he lived in Connecticut and then in Washington together with his wife Mary Henderson, and served among others as Chief Medical Officer Sorbent Therapeutics Inc. Vernon Hills, Illinois. His last scientific paper was published as recently as 2015 (2).
So many – patients and their families, physicians, nurses, researchers – owe so much to Lee Henderson for his work as physician, pioneering research in dialysis, and for his support to kidney disease research through Baxter´s Extramural Grant Program (Renal Discoveries). Many colleagues and friends in the Nephrology community all over the world will miss him.
On behalf of the many whose lives were enriched by meeting this remarkable man, by his work and his friendship.
1. Bergstrom J, Lysaght M, Cheung AK. The career of Lee W. Henderson. J Am Soc Nephrol 13: Suppl 1:S1-2, 2002
2. Henderson LW. Discovering the Presence of Convective Transport: An Artiphysiological Moment in Time. Artif Organs 39:985-8, 2015
Prof. Luis Hernando (1926-2017)
In Memoriam – Prof. Luis Hernando (1926-2017)
Spanish Nephrology is mourning
Professor Luis Hernando Avendaño died on 5 May 2017 at home in Madrid. Spanish Nephrology is mourning the sad news.
The history of Nephrology could be his own chronological and intellectual biography, mentoring Spanish Nephrology for almost 60 years. Until recently, he sat in the front row of every annual Sociedad Española de Nefrología (SEN, Spanish Society of Nephrology) meeting, from the first to the last presentation, displaying indisputable moral authority and the high standards that he had demanded from himself throughout his professional life.
Training in the US
After Medical School, he completed his training in Oxford, Hamburg and the United States, following advice by his father Professor Teofilo Hernando and his mentor Professor Carlos Jimenez Diaz, two key figures of Spanish Medicine. At Peter Bent Brigham Hospital in Boston (1954-1955), he was mentored by Professor George W. Thorn and did lab research on aldosterone, a recently discovered hormone. Concomitantly, he was mentored by Professor John P. Merrill on clinical nephrology, hemodialysis and transplantation. In fact, he fondly remembered that day on call when the first successful human kidney transplant was performed. This early combination of clinical care, laboratory research and training in Boston marked his professional activity and the design of the Nephrology Department at Fundacion Jimenez Diaz, providing a (what was later called) translational approach to kidney disease.
Return to Spain
In 1956, he returned to the recently inaugurated Clínica de la Concepción (later Fundacion Jimenez Diaz) in Madrid as Associate Chief of Internal Medicine. The March foundation funded the setting up a renal electrolyte and acid-base laboratory. For two years, he combined Internal Medicine clinical care and experimental research in the Lab.
Nephrology is born
In 1960, a multidisciplinary group of kidney aficionados, including Luis Hernando, met at Evian, France, and chose the name Nephrology for this area of Medicine. The first “Nefrología” department in Spain was born at Fundacion Jimenez Diaz and he was the first Chief of Nephrology (1962). From then on, he devoted to disseminate Nephrology throughout Spain in collaboration with early Catalan nephrologists.
Spanish Nephrology is born
He was a founding member and first Secretary (1964), second President (1967) and first Honorary member (1974) of the SEN as well as the first Editor-in-Chief of the Nefrología journal (1981). A milestone was the publication, in February 1968, of a special issue of Revista Clínica Española devoted to the new specialty, Nephrology. In 1970, he coordinated the National Plan on Nephrology, involving the half dozen existing Spanish Nephrology Departments. The plan was assumed by the National Health Service and led to an explosive growth in the number of Nephrology Departments in Spanish Hospitals.
He was a founding member of the Iñigo Álvarez de Toledo Renal Foundation (1982) devoted to promote Nephrology care and research in Spain and Latin America.
Contribution to International Nephrology
He also contributed to the success of the International Society of Nephrology (ISN) as Member of the Nominating Committee (1981-1983), Council member (1990-1996) and President of the XIII ISN Congress in Madrid (1995).
Department of Nephrology at Fundacion Jimenez Diaz
He imbued the Department of Nephrology of his vision and strong work ethic. The Department was designed from the start to combine patient care, teaching and research. A research biologist (Professor Lopez-Novoa) was a key contributor to the team, embedded among nephrologists. Nephrology Department Grand Rounds were famously held on Fridays at 5.00 p.m. Mentees left to inaugurate Nephrology Departments in Spain and abroad. While it is impossible to provide the names of all the great nephrologists mentored by Professor Hernando, we should specifically mention past ERA-EDTA President Professor Jorge Cannata-Andia.
Contribution to Fundacion Jimenez Diaz
Professor Hernando was Medical Director, Training subdirector and Clinical Subdirector at Fundacion Jimenez Diaz, providing a lasting imprint on generations of non-nephrologists.
Over more than 60 years he co-authored over 300 manuscripts, from 1953 (Lymphoma) and 1957 (Methods for aldosterone determination in the clinic) to 2014 (Quality of Nephrology healthcare, a collaboration with the recently created Spanish Kidney Research Network, REDINREN). He wrote or edited five books. Hernando´s Nefrología Clínica, first published in 1997, received the «Book of the Year» award and is the reference Nephrology textbook in Spanish speaking countries.
Training of MDs
Professor Hernando played an active role in the design of the newly created School of Medicine at Universidad Autónoma de Madrid, which soon became the best in Spain. He was Professor of Medicine, presided the Doctorate Commission of the School of Medicine and became Vice-President of the Spanish Society of Medical Education (1992-1995).
The MIR specialty training system
Professor Hernando had a passion for Specialty training. Together with Professor Segovia de Arana, he was one of the founding fathers of the MIR Specialty residency program. He fondly remembered when in 1988, the physician with the number 2 position in the nationwide MIR examination chose the Fundacion Jimenez Diaz to specialize in Nephrology. He went on to be President of the National Commission on Nephrology training (1979-1983, 1985-1990) and of the National Council on training for all Medical Specialties, and Spain representative at the Consulting Committee for Medical Education in the European Union (1988-1991).
Awards and honors
Over the years, he received a number of awards and honors. In interviews, he personally chose as most cherished the following: Member of the French National Academy of Medicine, Honorary Member of the Argentinian, Cuban, Paraguayan and Uruguayan societies of Nephrology and of Spanish Regional Societies of Nephrology; Gran Cruz Mérito Aeronáutico con distintivo blanco and Gran Cruz de Sanidad, Rodríguez Abaytua award (Spanish Royal National Academy of Medicine) to his PhD thesis and Gerardo del Rio award (Fundació Puigvert, 2005).
The ERA-EDTA recognized him during the 49th ERA-EDTA congress in Paris, as a Pioneer of the European Nephrology and an interview for the Masters of Nephrology was recorded (http://web.era-edta.org/luis-hernando). Together with the Honoris Causa Doctorate from the University of Alcalá (2004), promoted by Professors Manuel and Diego Rodriguez-Puyol, this was one of his most heartfelt moments.
In 2007, the Iñigo Álvarez de Toledo Renal Foundation instituted the Luis Hernando International Nephrology Award. Recipients include, among others, Professors Bernardo Rodríguez-Iturbe (Venezuela) and Giuseppe Remuzi (Italy) who donated the prize to create a Dialysis Unit named after Prof Luis Hernando in the Bolivian Amazon region. The Fundacion Jimenez Diaz created in 2013 the Dr. Hernando Avendaño Research Award.
Prof Luis Hernando was a pioneer of Nephrology that decisively contributed to the flourishing of the Specialty at a time when it was at the forefront of Medicine, developing clinical organ replacement and transplantation. Most importantly, he created a school of Translational Nephrology that continues to this day throughout the world, represented by his “scientific sons and daughters” and their “descendants”. Indeed, this is the distinctive flavor of training at the Fundacion Jimenez Diaz Nephrology and Hypertension Department, now led by Jesús Egido and Alberto Ortiz. Moreover, her daughter Paloma followed his steps as a physician. Sadly, Professor Hernando missed the graduation as a Doctor of his grandson Luis which took place on May 13, 2017.
Luis Hernando will be sorely missed by family, friends, colleagues and mentees all over the world.
Alberto Ortiz, Nephrologist, Luis Hernando mentee 1988-1991
Arturo Ortiz, Nephrologist, Luis Hernando mentee 1966-1968
Prof. Bengt Rippe (1950-2016)
In Memoriam – Prof. Bengt Rippe (1950 – 2016)
Professor Bengt Rippe died on the 20th October 2016 after a period of severe illness. He was Professor and Head of the Department of Nephrology, Lund University and Senior Consultant at the Department of Nephrology, Skane University Hospital Lund, Sweden.
Professor Rippe started at the age of 17 his studies in medicine but also in mathematics. He made an impressive research career at the Department of Physiology in Gothenburg and his results contributed extensively to an increased knowledge regarding the transcapillary transport, glomerular function and the physiology of peritoneal dialysis. His findings regarding the “the three pore model” for transcapillary transport was revolutionary in the field, and led to the later discovery of the “aquaporins”. Bengt Rippe received several honours and in 1988 he received the “Fernström” diploma for his outstanding research. Besides the extensive work at the research laboratory he also continued his medical career and became a skilled specialist in Nephrology.
Bengt Rippe was appointed as Professor in Nephrology, Lund University in 1990. In addition to impressive research, Professor Rippe was also heavily involved in both teaching at the medical school at Lund University and in the clinical work at the hospital.
Professor Rippe was president for the Swedish Society of Nephrology 2003-2005 and also an important spokesman for the establishment of the Swedish Renal Registry. He was always very eager to optimize the care, diagnosis and treatment for all the kidney patients, to improve patient outcome on dialysis and to increase the awareness of the renal diseases. Only a few days before his death he participated in the teaching of medical students, tutored his young research fellow at the laboratory and participated in clinical discussions. We will remember the generosity with what Bengt shared his knowledge and will continue to admire his humbleness that made his greatness so evident.
Bengt Rippe will be sorely missed by so many friends and colleagues.
Department of Nephrology, Skane University Hospital
Anders Christensson Head of Dept.
The Swedish Society of Nephrology
Kerstin Westman President
Prof. Carmelo Giordano (1930-2016)
In Memoriam – Prof. Carmelo Giordano (1930-2016)
(Born in Naples (Italy) on August 22, 1930, died in Naples (Italy), on May, 12, 2016).
Prof. Carmelo Giordano (Figure 1)
was born in Naples on august 23, in 1930. He completed his medical studies cum laude in Naples,
C.Giordano in 1954, at the faculty of Medicine of the University Federico II. After achieving the MD he moved to Boston (MA, USA) where he was trained in nephrology by Prof. John Putnam Merrill “The father of Nephrology as a discipline” (Prof. Murray Epstein), at the Peter Bent Brigham Hospital of the Harvard Medical School (“no Institution has done more for propagation of dialysis in the United States”). Upon his return to Naples he developed a laboratory for nutrition in renal disease, which was supported for the subsequent 21 years (1959-1980) by grants coming from the National Institutes of Health of the United States. He also started dialysis therapy for AKI using a Kolff-Brigham kidney, a personal gift given to him by Mr. Edward Olson, who was the manufacturer. Dialysis for ESRD was started in 1966. His dietary management of CKD patients (an example of self experimentation) was based on low protein diets of high biological value and rich in energy. Proteins were given as natural foods as well as under the form of L-essential amino acids. The safety and the efficacy of the diets was assessed by measuring the daily nitrogen balance (1-3). Subsequently he organized the first postgraduate school in nephrology (1971) at the University of Naples and the Ph.D. program in Nephrological Science (1980).Prof. Giordano’s group grew in numbers, quality and productivity and was ready to organize in the years 1971-1980 the Capri conferences and Award on Uremia. In 1975 Prof. Giordano received the tenure (as full professor of nephrology, which in 1990 was extended to internal medicine). The tenure in medicine lasted until 2005 (his last year at the University) and was associated with the direction of a division of medicine which was fully dedicated to renal transplantation from living and deceased donors.
Prof. Giordano was instrumental for the start of academical pediatric nephrology at the University Federico II in Naples (1980) and he pushed very hard in the Council the Italian Society of Nephrology to develop its own journal (Giornale Italiano di Nefrologia) which in 1983 was separated from the Gruppo Editoriale Minerva (Minerva Nefrologica). He also promoted the birth in Milan―with Wichtig Editore―of the International Journal of Artificial Organs (1975) and of The International Journal of Pediatric Nephrology (1980). In addition he was also elected dean for curricula for one term, and president of the Italian Society of Nephrology (for which he had been one of the 10 founders) and the first president of the college of university professors of nephrology. He received the Golden Kidney from the European Society of Pediatric Nephrology and a Special recognition from the International Society for Renal Nutrition and Metabolism. He also served for one term in the EDTA Council as an ordinary council member.
Particularly impressive is the list of novelties on renal nutrition discussed at ISN meetings: Prague (1963), Washington (1966), Florence (1975), and Athens (1981). In Prague his free communication on nutrition was unique for the topic. In Washington he showed that 75% of CKD patients on a diet providing 25 g of proteins were in positive nitrogen balance. In a plenary Lecture in Athens he acknowledged the impossibility for nutrition to compete with dialysis and transplantation and proposed to use it very early in the course of CKD (Early diet to slow the course of chronic renal failure). In that occasion he also definitely accepted the use of ketoacids as a nutritional therapeuthical possibility of in tervention, thus he was finally able to compound old dicords and acknowledged the role of Dr. Mackensie Walser.
However to fully appreciate Prof. Giordano’s contribution to renal nutrition one should refer to the Proceedings of the Congress on Nutritional Aspects of Uremia which took place in Scottsdale, Arizona on October 2-3, 1967 and published in the American Journal of Clinical Nutrition No. 21 (May and June 1968), which also reports on the debate between scientists. In recent years Prof. Giordano’s work has also been given a historical perspective (4, 5).
Prof. Giordano was very pleased by the paper of Prof. Denis Fouque and Prof. William E Mitch (NDT 2015; 30: 6-8):”In the history of medical sciences a few topics have been the focus of so many clinical trials, reviews, speculation, and discussions than the question of what constitutes an optimal protein intake for patients with kidney disease…. But probably we are reaching a consensus”. He felt that this tenet was strongly supported by: (i) studies of Prof. Massimo Cirillo et al. in the middle age population of the Gubbio Study showing that higher protein intake is associated cross-sectionally with higher GFR but longitudinally with greater GFR decline over time (NDT204; 29(9):1733-1740. (ii) data of Prof. Bruno Cianciaruso et al (AJKD 2009; 54(6): 1052-1061), (iii) those of Prof. Vincenzo Bellizzi et al. (NDT 2015;30:71-77), and by (iiii) a report on the costs of CKD therapy in the Campania Region authored by Prof. Giorgio Liguori et al (Igiene and Sanità Pubblica 2012;68:781-792), and by(iiiii) data of Biagio Di Iorio in Kidney Int (2007;7145-252.
Various creative clinical scientists worked during sabbaticals at the nephrological unit directed by Prof. Carmelo Giordano. The fist— Prof. Kazimierz Backzyk―who was later professor of Nephrology at the Medical University of Poznan (Poland) —arrived in Naples just in the days in which Eastern Europe was separated from the West with the construction of the wall in Berlin (Germany). Prof. Malcolm E. Phillips came to Naples from London as a Wellcome Trust Research Fellow for 2 years. His fellowship was arranged between Professors Hugh de Wardener and Carmelo Giordano. He studied amino acid losses and the effects of essential amino acid supplements in hemodialysis patients and the utilisation of D-amino acids and keto-acids in healthy and uremic patients (Lancet 1972). Later, when back in London, (Dr). Phillips was for varying periods General Manager of the Charing Cross Hospital and Medical Director of the Charing Cross and Hammersmith Hospitals. Prof. Otto Busato came from the department of nephrology at the University of Porto Alegre (Brazil) to work on nutrition and peritoneal dialysis. Also Prof. Alejandro Trevino Becerra came with the same goal and subsequently remained―as it is evident― anchored to the topic life-long. Prof. Francisco Gonzalez, Chair of Medicine and chief of nephrology at Louisiana State university during his stay attracted many young investigators to acid base balance in HD and PD and focused his research on pharmacological means to augment peritoneal dialysis clearances. The list of visiting scientists includes Professors Karl Julius Ullrich, Shaul Massry, Klaus Hierholzer, Gerhard Malnic, and Willem Kolff who was attracted by the use of sorbents for wearable kidney. In fact Prof. Giordano with Professors Yatzidis, Chang and Friedman introduced the use sorbents in medicine. The monograph on Sorbents and their clinical applications (Academic Press, New York 1980) is the outcome of such interest. The Group of Sorbents for Portable-Wearable kidneys was coordinated by Professor Renato Esposito (professor of nutrition and included Professors Giovanni Demma, Piero Bello (both Doctors in Chemistry), Prof. Ernst Quarto (bioengineer) and Prof. Giacomino Randazzo (Professor of Biochemistry), and finally also Doctor Norina Lanzetti (a nephrologist). They synthesized oxystarch and oxycellulose to be used orally (alone or in combination with charcoal) or for regeneration of dialysis fluid in wearable-portable kidneys. Both substances were potent binders for urea, and other nitrogenous waste products. Professors Esposito, Bello and Quarto also hypothesized the advent of inert material used for hydroponic cultivations to reabsorb water in human gastrointestinal tract. A field now in progress in many international laboratories.
This without forgetting the creative collaborations with Professors Jonas Bergstrom, Peter Furst (St. Erik Hospital, Stockholm), Garnar Ryhage, (Institute for Mass spectrometry at the Karolinska Institute), the group of Prof. Peter Richards at St. Mary Hospital Medical School (London) which gave birth to the use of ketoacids in health and uremia (Lancet 1971 and 1972), Prof. Ely A. Friedman (Suny, New York) for the use of charcoal and oxystarch in uremia.
Prof. Carmelo Giordano is survived by his wife Liliana and by their four children (all MDs): Drs. Dario Ranieri (university investigator in urology), Diego (university investigator in radiology), Mauro (Associate Professor of medicine and director of the specialty school in emergency medicine at the University of Campania Luigi Vanvitelli in Marcianise Caserta), Laura (Nephrologist), and by 13 grandchildren.
Prof. Giordano was pleased to participate in nephrological events in the Neapolitan area and he was a charming discussant. He used to participate to SURVIVAL is NOT ENOUGH held at the occasion of the World Kidney Day in Naples. Also this year he was at the Italian Institute for Philosophical studies (on March 10) where there were many of his previous fellows. He used all his charisma to stimulate
the audience to act as testimonial for kidney donation since “renal transplantation is the best therapy for uremic patients due its low cost, the quality of life granted and the length of survival.” This was the last occasion I saw him alive and brilliant. In that occasion he received an award from The Philosophical institute: a diploma for his life-long achievements in nephrology. Indeed his name and his contribution will be continually furthered by the many nephrologists he imprinted over the years, from 1959 onward, the year he started nephrology in Naples, in a 40 square meter laboratory on the third floor of the second pavillon of the Policlinico in Miraglia Square (that was then destroyed by the earthquake of Nov 23, 1980).
Prof. Giordano had also many hobbies. First of all he had great interest in the origins of Italian words (not necessarily related to medicine) and identifying stars at night by focusing from the terrace of his apartment with the telescope in the starry sky. In addition he had interest in Porsche cars and— much more— in sailing. With Black Swan (I-8155) he won various national and international races. Prof. Giordano’s Boat (I-8155) is nicely illustrated (Figure 2) in the Italian Lexicon Treccani (Vol XXIV, p.129) because of its peculiar capacity to advance transversally.
(Figure 2 – Black Swan)
Ciao Prof. Sit tibi terra levis/May the earth rest lightly on you.
Natale G. De Santo MD, Emeritus Professor of Nephrology, University of Campania ―Luigi Vanvitelli. Email: firstname.lastname@example.org, phone +393484117376
1.GIordano C. Treatment of uremia using essential amino acids and low protein diets. J Lab Clin Med 1963; 62: 231-246.
2.Giordano C. Treatment using essential amino acid and low protein diet. Proc. 2nd Int Congr Nephrol Prague, Excerpta Medica IntCongr series No.78, Basel Karger 1964:752-755
3.Giordano C, Esposito R, De Pascale C, De Santo NG. Dietary treatment in renal failure. Proc 3rd Int Congr Nephrol, Washington Vol 2, Basel Karger1966, 214-229.
4.De Santo NG, Cirillo M. Low protein diets are mainstay for management of chronic renal disease.Frontiers in Bioscience 2011; 3. 1432-42.
5.Di iorio B, DE Santo NG, Anastasio P, Perna A., Pollastro M.R., Di Micco L, Cirillo M. The Giordano-giovannetti diet. J Nephrol 2013; 26(Suppl.22)
Prof. Jules Traeger (1920-2016)
In Memoriam – Prof. Jules Traeger (1920-2016)
The Francophone Society of Nephrology, Dialysis and Transplantation regrets to inform you of the death of Professor Jules Traeger on May 25, 2016, he was 97 years old. With this sad event, an outstanding French and international nephrologist disappear.
Jules Traeger (1920-2016)
Professor Jules Traeger passed away on May 25, 2016.
The nephrology community honors the memory of this man who was one of the leaders in the field and who actively fought against kidney diseases. Professor of Medicine at the University Claude Bernard at Lyon in 1967, subsequently Head of the Nephrology Department from 1965 to 1986 at the Hospital of Antiquaille, and then to the Edouard Herriot Hospital in Lyon. He also was Director of INSERM U80 from 1968 to 1984. Prof. Traeger was the President of the French Society of Nephrology, the French Transplantation Society, the European Renal Association – European Dialysis and Transplant Association (1966), and contributed in 1960 to the creation of the International Society of Nephrology.
Professor Jules Traeger was very active in ERA-EDTA. A part from being President of both the Society and the Annual Congress in 1966, he was elected as an Honorary Member in 1988 and in 2011 he received the FERA (Fellow of the ERA-EDTA) title as well.
Professor Jules Traeger was Emeritus Professor of Nephrology, Corresponding Member of the National Academy of Medicine, and Honorary Doctor of many universities worldwide. In December 2003 he received the Commander of the Legion d’Honneur.
His work is immense in all areas of nephrology: pioneer of chronic hemodialysis and renal transplantation in France in the 60s; the first nephrologist who did research on anti-rejection treatments with anti-lymphocyte serum in 1963; home dialysis as founder in 1974 of the Association for the Use of Artificial Kidney in Lyon (AURAL) ; struggled for the multi-organ transplantations – he was also a tireless promoter of therapeutic innovations in recent years with a major contribution to the development of daily hemodialysis.
He was a man with a large curiosity, and was demanding, loyal and endearing. His countless collaborators and fellows keep a fond memory of this brilliant intelligence that has just passed away.
Ziad A. Massy
Prof. Evert J. Dorhout Mees (1925-2016)
In Memoriam – Prof. Evert J. Dorhout Mees (1925 – 2016)
On May 13, 2016 Prof. Dr. Evert Dorhout Mees passed away at home surrounded by his wife Mia and his family. Evert was still an active and passionate member of our nephrological community and mentored us over many years.
In the Netherlands Evert initiated home hemodialysis as early as 1967 and founded the first Home Hemodialysis Foundation, realizing as one of the first the heavy burden of hemodialysis treatment on the patient. He built a highly successful nephrology division recognized worldwide because of the clinical studies regarding regulation of extracellular fluid volume in healthy subjects in CKD and in nephrotic syndrome. He supervised many graduate students and nephrology Fellows, many of them still very active in the field of nephrology. During his long career, Evert was inspired by became befriended with Neil Bricker, during his stay in St. Louis, Arthur Guyton and Gabriel Richet amongst many others.
After his first retirement, Evert and Mia moved to Izmir in Turkey. Together they worked hard with the Turkish control adjusts to improve hemodialysis care, and Evert mentored one of us (EO) intensely, which led to a very successful program on fluid volume management and cardiovascular disease in hemodialysis that is recognized world-wide. When one of us (BB) visited Evert and Mia in Izmir, it was wonderful to observe how the intellect it fluently in Turkish was a patient was crowd a Turkish doctors, fellows, students and nurses around him.
Besides being a nephrologist and the scientist Evert was active as an advocate for human rights, and functioned as an observer on several trials. He shared with us how satisfying the many visits were to a Turkish journalist, who had been imprisoned in The Netherlands and with whom he interacted in Turkish. This is not where the story ends. Evert closely followed politics in many countries, always deliberating about injustice about events, he spoke six languages, loved to read and to talk about historical and cultural facts, and travelled with Mia to many places. Until his health started to decline in 2015, he was always actively hiking and played tennis until late in his 80s. Last but not least Evert and Mia raised their five wonderful children to become strong individuals.
When we were talking with Evert a few days before his passing, he expressed his concerns about the lack of pathophysiological understanding coming from evidence based medicine and this evidence is sometimes used as ‘absolute truth’. He cited Gabriel Richet: ‘En medicine s’ écarter peu ou prou de la physiologie conduit tô ou tard au suicide intellectuel’ (in medicine to depart more or less from the physiology leads to sooner or later to intellectual suicide).
In 2004, the ISN paid tribute to Evert and recorded his personal statements about nephrology in the Video Legacy Project. We and many with us will miss Evert as a great thinker, a mentor, a friend and an example of a beautiful intellectual. We wish Mia and the family strength to give this loss a place.
Prof. Jean-Philippe Mery (1929 – 2016)
In memory of Prof. Jean-Philippe Mery (1929 – 2016)
Very early in his life, Jean-Philippe expressed the wish to become a doctor, even if nobody of his family encouraged him to do so. He would have liked to become a hepatologist with René Cachera, who sadly died too early, so he decided then to become a nephrologist.
In 1945, he was a medical student in the well-known Department of Professor Louis Pasteur Vallery Radot, which counted 120 beds. His intern (resident) was Francois Lhermitte. At that time, they were working with Paul Milliez, Jean Hamburger, Claude Laroche, René Wolfrom and André Domart. Seduced by the rigor, the medical and the scientific knowledge of Jean Hamburger, he returned as a fellow, and was with him for nearly all his medical career. He also benefited from Fred Siguier and Jean Bernard’s teachings.
After 1950, Hamburger and Mollaret introduced new medical intensive care techniques, which first aimed at treating hydro electrolytic and respiratory disorders. When Gabriel Richet came back from the United States, he brought the first Kolff and Merill artificial kidney to the Necker hospital. All those who performed these first sessions of artificial kidney therapy will never forget this huge cylinder surrounded by a cellophane ribbon, submerged in a dialysis bath. The vascular access was performed by denudation. There was neither shunt nor arteriovenous fistula. It was extremely difficult, but how rewarding after having saved the lives of young women presenting acute renal failure after perfringens sepsis!
Later on, Jean-Philippe became the director of the AURA Pasteur Vallery Radot Centre, the biggest hemodialysis center in Paris. In the Necker hospital, he was present when the first percutaneous kidney biopsy was performed by Brun, who moved specifically from Denmark to do this biopsy.
With Jean Hamburger, René Habib, and Jean Berger, Jean-Philippe largely participated to the definition and classification of glomerular diseases. He confirmed his high interest in renal pathology in the Tenon hospital with Liliane Morel Maroger Striker. Their contribution was very important in the field of renal diseases due to immunological and haematological disorders.
Jean-Philippe participated to the writing of the first French textbook of nephrology, coordinated by Jean Hamburger in 1954. He also wrote numerous chapters in international books, in particular in the Oxford Textbook of Nephrology. We are particularly grateful for his coordination of the medical encyclopedia named “Le petit Hamburger”. We were far from the facilities of the internet, and Jean-Philippe, with his rigour and precision, gave a lot of time and interest to the constant revision of this book.
Jean-Philippe joined Gabriel Richet’s team in the Tenon Hospital from 1966 to 1980. In 1980 he created the nephrology Department in the Bichat hospital, the unique hospital in the north of Paris. Jean-Philippe assumed responsibilities within our community. In particular, he was the president of the French Society of nephrology from 1989 to 1991, the president of the 52nd section of the National Council of the Universities (CNU). He also was a council member of the EDTA board in several occasions.
Jean-Philippe was also a sincere and loyal friend, with whom we (with Prof. Fillastre) enjoyed discussing literature, cinema, theatre, going to exhibitions in Paris or in Rouen. As for Prof. Fillastre, it was a real pleasure to be with him, in Bordeaux when he was given the Jean Hamburger Medal. We send our friendly thoughts to his son David and to all his family.
JP Fillastre and Z Massy
Prof. Dr. Cengiz Utaş (1959 – 2015)
In memory of Prof. Dr. Cengiz Utaş (1959 – 2015)
“You only live once, but if you do it right, once is enough.”
The sudden and very untimely loss of former ERA-EDTA Council Member Prof. Dr. Cengiz Utaş at 56 years of age after a heart attack came as a great shock to the entire Turkish Nephrological Community as well as his friends in ERA-EDTA and elsewhere in the world.
The late Professor Utaş was a prominent member of the Turkish Society of Nephrology (TSN). He served as TSN Executive Board member for 11 years (2000-2011) and also as Vice-President of the Society for 3 years (2008-2011). He headed various TSN Committees responsible of Congress & Meeting Organization, of Publications, of Scholarships and of International Scientific Relations. He also served for 14 years (1994-2008) as Editor in Chief of TSN’s Official Publication “the Turkish Journal of Nephrology Dialysis Transplantation (TNDT)”. He has regularly contributed to TSN annual National Congresses as lecturer, panelist, symposium member, Congress Secretary and Congress President. He was also actively involved in TSN’s many Educational and Training Courses both as organizer and member of teaching faculty. In fact, he was the initiator of the very successful yearly TSN Winter Schools, now in their 13th year.
Professor Utaş was not only a good clinician and a successful academician, but also an outstanding administrator. In 1993 he founded the Erciyes University Medical Faculty’s Department of Nephrology in Kayseri, Turkey, which he chaired until 2004. He later served as the Vice Dean (1996 – 2000) and then the Dean (2000-2002) of the same Faculty. He then was elected and served as President (Rector) of the Erciyes University (2004-2008) a large Central Anatolian State University comprising 18 Faculties, 12 Colleges, 7 Institutes, 38 research centres and a total number of 60.000 students. During his rectorship term, he made significant contributions to Erciyes University on structural, technical, social, and most importantly academical grounds. From 1993 up to 2014, he authored and co-authored 123 international publications related to Nephrology. He edited four textbooks on Nephrology and Dialysis in Turkish and authored or co-authored many chapters in Turkish textbooks in the field.
Within a time span of seven years, Professor Utaş has served as Congress Secretary to two different ERA-EDTA Congresses which has been organized both in Istanbul: the 42nd Congress in 2005 and the 50th Anniversary Congress in 2013. In both occasions, he has contributed greatly to the local Organization and the Social Program including the organization of Pre-congress Council Meetings, Opening Ceremonies and Presidential Dinners and thus played a crucial role in the unquestionable success of both Congresses. In 2005, he became Editorial Board Member to the NDT journal and remained so for many years. From 2005 to 2008, Professor Utaş has worked as elected member of the ERA-EDTA Council. He genuinely enjoyed his Council term and with his well proven creative and innovative managerial and organizational skills together with his exceptional aptitude for collaborative scientific and administrative team work, we have every reason to believe that during this term he made a worthy positive contribution to the work of ERA-EDTA concerning the development and advancement of Nephrology in Europe. We also think that his work for ERA-EDTA as Congress Secretary and then a Council Member greatly fulfilled his long-standing aspiration for the better integration of Turkish Nephrology to European and World Nephrology.
Professor Utaş was also a very active member of the TSN Peritoneal Dialysis Study Group (also known as TULIP) that engaged in many peritoneal dialysis related multicenter research projects nationwide and also at the international level resulting in many international publications. As such, he quickly became known in the ISPD circles and was appointed to preside the 2008 ISPD Congress in Istanbul which, thanks to his efforts turned out to be one of the most successful ISPD Congresses ever.
Professor Utaş who always gave primordial importance to the advancement of Nephrology in South-Eastern Europe and the Balkans was also an esteemed member of BANTAO. As such, he assumed the role of Congress Secretary and worked very hard for the social and scientific organization of the legendary 2009 BANTAO Congress held in Antalya, Turkey.
His fellow TSN Executive Board Members who worked with him during his 11 years of service on the TSN Board will remember him as “the Planner”, “the Organizer”, and “the Driving Force” behind many leaping achievements of TSN and Turkish Nephrology in the past decade.
Most importantly, he was a loving and dedicated husband to his wife Serap Utaş, a Professor of Dermatology, and a devoted and caring father to his son Alper Utaş, a successful lawyer at one of the top law firms in Istanbul. To his friends, he will remain a very warmhearted, caring and larger-than-life person to be always remembered for his good deeds. May God bless his benevolent soul and give solace to his loving friends and family.
Rest in peace, our beloved friend Cengiz. Your contributions to the Turkish and the European nephrology will always be remembered.
Turkish Society of Nephrology
Prof. Utaş was delivering his address as Congress Secretary
at ERA-EDTA 42nd Congress President’s Dinner in Istanbul, 2005.
Prof. Gabriel Richet (1916 - 2014)
In memory of Prof. Dr. Gabriel Richet (1916 – 2014)
Born in 1916 during the First World War, Gabriel Richet was the fourth of a lineage of famous medical faculties, all professors at the Faculté de médecine in Paris, including his grandfather Charles Richet who was awarded the Nobel Prize in 1913 for the discovery of anaphylaxis. Gabriel Richet was 23 years at the outbreak of the Second World War. He had just passed the highly competitive residency examination. He was called up and actively participated in the France military campaign. After being shortly held in captivity, he returned to Paris and resumed medical activities. All members of his family actively participated in the fight against occupation. His father, Charles Richet, was deported to Dachau, his brother Olivier to Dora, his cousin Jacqueline Richet-Souchère to Ravensbrück. His mother Marthe was put in jail at Fresnes (close to Paris). Soon after the liberation of France, Gabriel Richet enrolled in the army under the high command of General Leclerc whose army freed Strasbourg in November 1944. In the first months of 1945, fights continued in the area of Colmar in the South of Alsace where Gabriel Richet was active as a doctor of the French commandos. He was injured, received
3 military citations and was decorated with the award of “Chevalier de la Légion d’Honneur” by the General de Gaulle in April 1945.
Demobilized from the army, Gabriel Richet joined the department of Louis Pasteur Valléry Radot where he met Jean Hamburger whom he followed to Necker Hospital to establish in 1950 the first French department of nephrology. He remained the assistant to Jean Hamburger for 10 years and ranked with him among the rebuilders of the after-war French medicine. At the Necker, he introduced treatment of acute kidney injury with the artificial kidney which dramatically improved the prognosis of post-abortum sepsis and crush syndrome. He participated in all the works and studies that contributed to the world-wide reputation of this department. Among those, the first allogenic kidney transplantation from a mother to her son which opened up exciting perspectives and success, the breaking up of glomerular nephropathies that was made possible by histological analysis of kidney biopsy specimens, the first kidney studies by electron microscopy, the demonstration that the deadly prognosis of end-stage renal disease was dependent on electrolyte disorders rather than uremia. As early as 1955, he developed with Jean Hamburger and Jean Crosnier the concept of renal intensive care (réanimation médicale) aimed at correcting disorders of the major metabolic functions, thus opening new therapeutic perspectives.
In 1961, Gabriel Richet came to Tenon hospital, at that time in the middle of nowhere, where he founded a renal clinical and research center. His first objective was to create a team with Claude Amiel, Raymond Ardaillou and Liliane Morel-Maroger, later joined by Françoise Mignon, Jean-Daniel Sraer, Pierre Ronco, Eric Rondeau and many others. He was supported by Assistance Publique-Hôpitaux de Paris (the institution of hospitals in Paris) which erected a new building for clinical wards and laboratories, by INSERM (the French NIH) which created a research unit under his direction located in new facilities, the University, the Claude Bernard Association and the CNRS (National Center for Scientific Research) which provided equipment and consumables. Gabriel Richet wanted Tenon to become a center of excellence for renal diseases as well as an intellectual haven (a “foyer intellectuel” as he often said). He fully succeeded if one counts the large number of fellows from many countries all over the world that were trained in the Tenon Babel tower and became a member of his “school”. He considered that each of them was a great contributor to the collective advancement of knowledge and to the success of Tenon. It is obviously impossible to describe here the works and discoveries that took place during this 24-year period. Suffice to say that Gabriel Richet had his own group of research and was proud of the discovery of the dark cells of the collecting duct, now called intercalated cells, which play an important role in acid-base control. But even more importantly, he let a great freedom to all his collaborators in the choice of their own research project and was very happy when they reached international recognition.
Gabriel Richet is one of the early giants of French and international nephrology. He was a founding member of ISN. Among his many roles in ISN leadership, he was co-General Secretary of ISN’s first Congress in Geneva and Evian in 1960, and ISN President from 1981-84. He received many awards including Honoris Causa Degrees; among those awards, the most prestigious probably was the Jean Hamburger Prize of the ISN in 1993. Gabriel Richet was appointed Grand Officer of the French Legion of Honour in 2012, soon after he had opened our ERA-EDTA annual meeting in Paris.
On his retirement in 1985, Gabriel Richet’s heritage included two renal divisions with quite different medical orientations, a clinical investigation center, an INSERM research unit, without counting the many nephrology and physiology departments directed by his fellows in France and far beyond. Thanks to his impetus, Tenon hospital has conserved a high standard in the concert of international nephrology. The deeply translational spirit of the medical and scientific actors, the available facilities and the nephrologists that are working there carry the trademark of this charismatic great Master who has profoundly imprinted nephrology which he contributed to establish.
Raymond Ardaillou is the perpetual secretary to the national academy of medicine.
Pierre Ronco is director of the department of nephrology and dialysis and of the INSERM research INSERM 1155 at Tenon hospital, Professor of renal medicine at University Pierre et Marie Curie, and member of the national academy of medicine.
The Masters of Nephrology: Interview with Gabriel Richet
Prof. Claus Brun (1914 - 2014)
In memory of Prof. Dr. Claus Brun (1914 – 2014)
At the death of Claus Brun, a few months after his 100 years Birthday, Danish, European and International Nephrology have lost one of their great founding personalities.
Claus Brun was a nephrological pioneer, who in the late 40s introduced the technique of performing a percutaneous kidney biopsy. He created the basis for our understanding of renal histopathology and its correlation with functional and clinical data. He eagerly participated in the international exchange of ideas during these early days and became the President of the International Society of Nephrology (ISN) from 1963 to 1966.
Claus Brun was born in 1914 in Copenhagen. He graduated from University of Copenhagen in 1940. Claus Brun worked for almost his entire professional life at the Municipal Hospital in Copenhagen until his retirement in 1984.
Claus Brun became specialist in Clinical Biochemistry in 1948 and in Nephrology in 1969.
Together with Poul Iversen, Claus Brun was the first to publish the method of doing a percutaneous kidney biopsy in their classic paper, “Aspiration Biopsy of the Kidney” in Am J Med 11:324-330, 1951. The authors obtained adequate biopsy tissue in 42 out of 66 patients with a minimum of bleeding complications. They also described the ability to make diagnoses of amyloidosis, diabetic nephropathy, hypercalcemia, and glomerulonephritis based on the pathology.The percutaneous kidney biopsy has ever since created the possibility of obtaining the correct diagnosis and as such provide the optimal treatment for a very large number of patients worldwide with kidney diseases.
In 1956, Jean Hamburger, at the L’hôpital Necker invited Claus Brun to come to Paris and demonstrate the kidney biopsy technique and the histological results, leading to establishment of an international network of scientists interested in kidney function and disease. In 1960 they organized the First International Congress of Nephrology with 400 participants. Jean Hamburger became the first President and Claus Brun the second President of ISN. He became President of the Danish Society of Nephrology in 1969 and was awarded the prestigious Novo Nordic Award in 1964 and later he received the Knight’s Cross of the Order of the Dannebrog.
Claus Brun’s way to nephrology was based upon a lifelong scientific and clinical interest in patients with acute and chronic kidney diseases. His doctoral thesis from 1954 was on:” Acute anuria, A Study based on renal function tests and aspiration biopsy of the kidney” and was based upon his clinical observations at the Municipal Hospital in Copenhagen, his work at Department of Clinical Biochemistry, and based upon experiences from his sebatical in USA at Department of Physiology, New York University og Mt. Desert Island Biological Laboratory, Maine, where he from 1952 to 1953 had the great fortune to work together with Homer Smith.
He was interested in clinical nephrology and in the physiological aspects of acute and chronic kidney failure and was the first in Denmark to introduce an artifical kidney. Claus Brun published a large number of scientific papers, many in the best scientific medical journals.
Claus Brun became Chief Physician in 1956 at the Department of Clinical Biochemistry at the Municipal Hospital in Copenhagen, and created there his lab of kidney pathology. Claus Brun was known all over the world for his high quality work, his biopsies were always of the best quality and the careful description always at the highest level. His histological work has for years been the golden standard and his histological atlas on glomerulonephritis together with Steen Olsen used all over the World.
Claus Brun had a number of interests beside his scientific fascination of kidney biopsies.
Thus, in1968 he and his wife, Xenia, were invited to visit Butan. They became involved in treatment of patients and made an assessment of the overall health situation. Claus Brun went back in 1979, and suggested that the Bhutanese requested the Danish authorities for a hospital and back-up training.
Claus Brun was an eager iceskater and was always the first on the ice of the small lake where he lived.
The World has, at the death of Claus Brun, lost a briliant and engaged nephrologist, from whom we have learned a lot. Our thoughts and sympathy go to Xenia, Claus Brun’s wife, who through all the years has been a deeply involved partner in the life of Claus Brun, and to his daughter and son-in-law.
Copenhagen, October 4, 2014
Bo Feldt-Rasmussen, Lisbet Brandi & Klaus Olgaard
Prof. David Nicol Sharp Kerr (1927 - 2014)
In memory of Prof. David Nicol Sharp Kerr (27.12.1927 – 20.4.2014)
Recently we lost David Kerr, the last of the triumvirate who formed the EDTA half a century ago in 1963-4. Some time ago in 1992 we lost also Wim Drukker, only last December Stanley Shaldon died, and now David Kerr has gone. The chains that bind us to the past are gently slipping away….
David Nichol Sharp Kerr was born in Hackney on 27th December 1927. Strangely, Stanley Shaldon was also born in this same borough of London four years later, although neither of their families had their origins in that area. David came from a family of Scottish origin – the Kerrs are a notable lowland clan from between Kelso and Jedburgh in the borders with England. Thus he was sent up to be educated at the famous George Watson’s Boys School in Edinburgh, and then studied medicine at the University of Edinburgh, qualifying MB ChB with Honours in 1951.
After initial junior doctor appointments in Edinburgh he went in 1952 to the University of Wisconsin and studied for an MSc in Anatomy. Then from 1953-1955 he undertook National military Service as a surgeon-lieutenant in the Royal Naval Volunteer Reserve. He returned to the Department of Medicine in Edinburgh before being appointed as a registrar in medicine at the Hammersmith Hospital. Whilst training in hepatology he was encouraged by Sheila Sherlock to move to Newcastle where George Smart was establishing a dialysis unit. David was told that he would be in charge of the renal unit “in his spare time”. Thus David’s career in Nephrology started rather late, when he was already 31 years old.
He was initially appointed First Assistant in Medicine in the Medical School, King’s College, University of Durham in 1959 and became Lecturer in Medicine at Newcastle University in 1961. He was promoted to Senior Lecturer in 1963 and subsequently was appointed to a Personal Chair in Medicine in 1968. Appointed Professor of Medicine and Head of the Department of Medicine in 1971, he stayed in this post until his departure to become Dean at the Royal Postgraduate Medical School, London in 1983.
In the 24 years that he spent in Newcastle he established an academic renal unit with an outstanding international reputation. The breadth of the research that he fostered in this time is evidenced by the range of publications that came out of the unit. Not surprisingly he was particularly interested in the technical aspects of dialysis and its complications. In Newcastle, dialysis for acute renal injury began in 1959 using a machine designed by Nils Alwall in Sweden, rather than rotating drum models or the coil designs of Kolff and Watschinger used elsewhere throughout the United Kingdom. Soon after in 1964 his unit was amongst the first in the UK to undertake long-term haemodialysis for irreversible renal failure, using a Kiil-type rebuildable flat-plate dialyser. This work lead to the seminal observations in Newcastle on the role of aluminium derived from the water supply in the development of bone and brain disease in dialysis patients. David instilled the importance of clinical observation in research into all of those who trained in Nephrology in Newcastle during this period. This led to a series of studies examining the natural history of conditions including renal bone disease, reflux nephropathy, and hypertension as well early observations in renal transplantation. Whilst he was primarily a clinical researcher, he recognised the importance of applied basic science and was an early champion for the use of molecular genetics in clinical research.
David established Newcastle as one of the best and happiest places in the UK to train in Nephrology. This legacy is still to be seen in the consultant staff of renal units throughout the UK. In addition to this he had a passion for training clinicians from overseas, particularly from developing countries. A steady stream of overseas fellows were to be found in that period in his clinics and laboratory. Not only interested in their academic and clinical training, David took great personal responsibility for their pastoral care. As a result he is held in great personal affection by nephrologists spread across the globe.
He left Newcastle in 1983 to take up the post of Dean of the Royal Postgraduate Medical School, which he held until 1991. During this time David steadfastly and calmly steered the School through a period of financial and administrative turbulence. Despite the huge administrative burden of the Dean’s post David still found time to remain true to his clinical and academic calling. He made a valuable contribution to the clinical service in Nephrology, and always found time to provide wise advice to colleagues and trainees. He also established a course leading to a Diploma in Nephrology which was extremely popular with overseas trainees, many of whom went on to successful careers in their home countries. Not surprisingly his portrait as Dean (Figure 1) shows him surrounded by a group of international students, rather than in a formal solitary pose.
Courtesy: Wim Drukker Vittorio Andreucci Royal Postgrad Med School
(Artist unknown – “JP”)
(Figure 1) David (left) in a thoughtful pose at the first EDTA meeting in 1964, (centre) in middle life at the College of Physicians in London, (right) as Dean of the RPGMS
David’s esteem in the field of Nephrology was marked by numerous prestigious invited lectures and awards too numerous to list here
Central to this narrative, he was one of the three founding members of the European Dialysis and Transplantation Association in 1963. That year, the International Society of Nephrology held its second meeting in Prague, so that Europe was full not only of local nephrologists but also Americans and Antipodeans. Stanley Shaldon exploited this happy fact by organizing a meeting at his own hospital, the Royal Free in North London, at which the topic of acute renal failure (today re-branded as “acute renal injury”) and its treatment by haemodialysis was explored. Wim Drukker and David attended the meeting, and both suggested independently to Stanley that a Society be formed to have more similar meetings on topics related to dialysis, for European nephrologists. This topic was explored and progressed between the three pioneers after the dinner held in the magnificent hall of the Society of Apothecaries at the end of the meeting, and a decision to begin a society determined. David has left us his account of these events , as has Wim Drukker , and Stanley’s account is available on video.
The initial idea of the triumvirate was to have a small, selective society confined to Western Europe (the Western European Dialysis Association, WEDA) which would deal only with the application of dialysis to renal problems, and planning was begun for a meeting in 1964. This model was rapidly overtaken, however, especially at a preliminary meeting at which several others, in particular Gabriel Richet of Paris argued for a grander model, incorporating participation from all over Europe, including the then-entrenched and politically hostile East European bloc, thus involving larger numbers of participants. Others suggested that transplantation should be included, even though its value and future remained in doubt in 1964 , so that the first meeting of the new Association was as the “European Dialysis and Transplant Association” (EDTA), even though at the first meeting in the Wilhelmina hospital in Amsterdam in 1964, no papers on transplantation were actually presented! Around 100 people from all over Europe participated, and a few Americans attended; a pattern which was repeated during the following decade. David played a major role in organizing the second meeting held in 1965 in Newcastle, but with characteristic modesty allowed his surgical colleague and transplant surgeon John Swinney to be President of the meeting. From 1964 to 1969 he became the first editor of the annual Proceedings of the meetings, and from 1976 to 1979 was an elected member of the Council.
In 1983, when the meeting of the EDTA came to London, he was already President of the Renal Association of the United Kingdom, and who else could be President of the EDTA conference? In 1986 at the Budapest meeting of the EDTA, in recognition of his enormous contributions, he was acclaimed an honorary member. In his personal view of the history of the Association  he dealt with the fact that none of the initial plans he and his colleagues had made in 1963 had become permanent, but had evolved and been expanded and improved. These included finally the suggestion of Arthur Kennedy of Scotland when President in 1971, and brought to fruition later by Vittorio Andreucci in 1985 , to introduce general Nephrology into the repertoire and very name of the Association – an initially controversial change, not to the taste of all members then or since. Shaldon remained a firm opponent of this move. In 1985 David had no role in burying the Proceedings he had begun, as it had become obvious that the reputation of the Association could be better served by a Journal, which became Nephrology Dialysis Transplantation. However he wrote in 1989  “Although I launched the Proceedings, I shed no tears for it……in today’s competitive environment, the only publications that matter are those in peer review journals” . The decision to start a journal, its name and abbreviation, were all made rapidly in the manner he used so successfully, at an informal, open-air lunch outside the Duomo in Florence at the 1985 meeting of the EDTA, which included Vincenzo Cambi and the journal’s first editor-in-chief-to-be, Sandy Davison, and myself.
By this time David was Dean at the RPGMS, but he also served as Vice-President of the meeting of the International Society of Nephrology, again in London, in 1987 – he had served as a Council member in the ISN. He continued, later in his life, to support many aspects of Nephrology in the UK, notably as President of the leading British research charity in renal disease, Kidney Research UK, from 2000-02.
He had also a long association with the Royal College of Physicians of London, which he served with distinction. He was invited having been judged as the most brilliant new fellow to give the Goulstonian lecture in 1968, and later was also invited to give the Lumleian lecture in 1983. He served the College as censor 1982-84, senior censor 1990-91, and was editor of the College Journal from 1994-98. He was also a fellow of the Edinburgh College of Physicians from 1967, and was nominated CBE by the Queen in 1991.
David was truly the nicest of men, with remarkable modesty despite his many achievements and a dry sense of humour. He always spoke softly, but had a determination to succeed and to complete which underlay everything he did. Underpinning and at the centre of David’s life also was his Christian faith; these values were clear to see to all who were privileged to have known David during his life. For a time he was a lay preacher in Newcastle.
Later in life he was troubled by deafness, but characteristically made light of this handicap. In 2007 he was diagnosed with Alzheimer’s disease, and early in 2008, at probably the last meeting to which he contributed  on the introduction and history of dialysis in the UK, he was forthright in announcing this to us, his friends and colleagues at the meeting. Nevertheless, he was determined to contribute to an occasion he thought important. He was a delight to know, and an unbearable loss.
He is survived by Eleanor his wife of 53 years, three children and four grandchildren. He will always be remembered fondly, not only by his family but by his many colleagues, pupils and friends all over the globe.
J Stewart Cameron
1.Kerr DNS. 25 years on. EDTA to ERA. Nephrol Dialysis Transpl 1989; 4: 411-5.
2.Drukker W. The Founding of the EDTA: Facts and Lessons. Nephrol Dialysis Tanspl 1989; 4: 401-7.
3.Hamilton D. A history of organ transplantation. Pittsburg, University of Pittsburg Press, 2012.
4.Andreucci V. History of the ERA-EDTA. Memoirs of a former President. Clin K J 2012; 5: 180-6.
5.Crowther SM, Reynolds LA, Tansey EM. Wellcome Witnesses to Twentieth Century medicine. Vol 37. History of dialysis in the UK: c.1950-1980. London, Wellcome Trust, 2009.
Prof. Wojciech Rowiński (1935 - 2014)
In memory of Prof. Wojciech Rowiński (1935 – 2014)
With the great grief and sorrow we have learned about Professor Wojciech Rowiński passing away on the 14th of March 2014.
He was pioneer and co-founder of polish transplantation medicine – from the first successful kidney transplantation in which he participated in 1966, up to current shape of polish transplantation as modern multidisciplinary specialty.
Professor Wojciech Rowiński was outstanding physician, surgeon and transplantologist, as well as academic teacher and scientist.
He was founder and chair of the clinical Department of General and Transplantation Surgery in Warsaw Medical University, which he led for 26 years developing it to multidisciplinary team transplanting kidneys, pancreas and liver, as well as performing broad spectrum of general surgical procedures.
He was director of Transplantation Institute in Warsaw Medical School in 1995-2004 (WHO collaborating center), for many years he was national consultant of transplantation medicine as well as Chairman of National Transplantation Council (1995-2006).
Professor Wojciech Rowiński was author and co-author of several chapters in books and over 300 publications in international journals.
He was respected academic teacher involved in teaching of nurses, physicians and dentist, under his care there were several doctorates thesis defended, as well as few habilitations and professors promotions.
He was President of European Society of Organ Transplantation (2001-2003), Polish Transplantation Society (2007-2009), member of ASTS/AST, IPITA, ITS, ISODP, ESSR. Since 1996 until 2007 he was founder and Editors-in-Chief of Annals of Transplantation journal.
Due to his achievements, knowledge and personality he was recognized and respected member of international transplantation environment.
Professor Wojciech Rowiński was founder and President of Polish Union of Transplantation Medicine, NGO dedicated to promotion of transplantation and organ procurement as well as program Partnership for Transplantation, to which he dedicated the majority of activities in last few years.
We have lost righteous man and humanist. Professor Wojciech Rowiński will always remain in our memory.
Raymond Vanholder (ERA-EDTA President)
Ziad A. Massy
Gert J. Mayer
Mehmet S. Sever
Prof. Stanley Shaldon (1931 - 2013)
In memory of Prof. Stanley Shaldon (1931 – 2013)
“With the death of Stanley Shaldon we have lost a brilliant nephrologist and one of the pioneers and most creative spirits of our specialty”, explains Prof. Raymond Vanholder, Ghent, Belgium, president of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA).”Stanley was highly visionary and fifty years ahead of his time, when he initiated home dialysis, nocturnal dialysis, and extended dialysis treatment: all options that only started thriving during the last decade”.
Prof. Shaldon was born in 1931 in London and studied medicine at the University of Cambridge, Queens´ College London and the Middlesex Hospital London from 1949-56. After he had spent two years in military service as a medical specialist at a hospital in Lagos, Nigeria, he got his postgraduate training at the Hammersmith Hospital and the Royal Free Hospital, London, where he became Lecturer in Medicine in 1960 and Consultant Physician to the Renal Unit in 1965. Only one year later, in 1966, he set up the National Kidney Centre in London. In the seventies he left England and worked as visiting professor in Montpellier, France, and Stockholm, Sweden. From 1977 until receiving emeritus status he was responsible for the research section of the Department of Nephrology at the University Hospital in Nimes, France.
Prof. Shaldon’s scientific work was outstanding, with over 350 peer-reviewed publications as a pioneer in the fields of (home) haemodialysis, ultrafiltration and treatment of ESRD, including ground-breaking clinical inventions. He developed an arteriovenous fistula which was simple to puncture in self care and was also the first one to apply central vein catheters as access for dialysis, now known as the “Shaldon-catheter” (Lancet 1961) all over the world. He also was one of the first to reuse dialyzers, and even more importantly, he drew attention to the significance of pure dialysis water, of chemokines in uremia and last but not least, of the toxicity of dietary salt. He was an excellent nephrologist and the patients were always at the center of all his efforts. His dream was “to make dialysis the insulin of end stage renal disease”, meaning to enable patients to perform dialysis themselves and being less dependent on medical assistance. In a video that was produced in 2010 during the ERA-EDTA’s annual congress he explained his vision and gave an interesting insight into the pioneering years of dialysis (please visit www.era-edta.org/page-3-14-132-132-stanleyshaldon.html).
Furthermore, Prof. Shaldon was a great teacher and mentor bringing up and influencing many of the current generation of European and world-wide nephrologists. He also was one of the “founding fathers” of the ERA-EDTA in 1963. His vision granted the development of one of the most successful European Scientific Societies today – with now more than 6,600 members – which he inspired for many years. For all his major clinical, scientific and personal contributions, Prof. Shaldon was appointed as Honorary Member of the ERA-EDTA in 1994. In 2011 he was awarded the “ERA-EDTA Award” for his outstanding contributions to nephrology; finally in 2012 the ERA-EDTA renamed its young nephrologists´ award into the “Stanley Shaldon Award for Young Investigators”.
“Unfortunately, Stanley could deliver the prize only once in person, last year at the ERA-EDTA congress in Istanbul. We are very grateful to him for all he did for the ERA-EDTA and nephrology in general. We will always remember him as a great scientist and miss him dearly as a good friend”, explains Prof. Vanholder.
Raymond Vanholder (ERA-EDTA President)
Ziad A. Massy
Gert J. Mayer
Mehmet S. Sever
Prof. Dr. Walter Hörl (1945 - 2013)
In memory of Prof. Dr. Walter Hörl, Vienna/Austria, (1945 – 2013)
The ERA-EDTA is in mourning for Prof. Walter Hörl, who died unexpectedly at the age of 67.
Prof. Walter Hörl was one of the doyens of nephrology in Europe, and rendered outstanding services to the field. After completing his studies in Würzburg and Bochum, he was associate professor at the University Hospital of Freiburg, and then spent two years in the role of medical director of the Clinic of Internal Medicine IV at the University Hospital of Homburg (Saar). 1992 saw him move to the University of Vienna to assume the role of head of the Clinical Department of Nephrology and Dialysis at the Medical University of Vienna, where he remained until this very day. Walter Hörl conducted pioneering research into a wide variety of fields; topics of note on which he focussed his research included immunodeficiency in uraemia, uraemic toxins and renal anaemia. He authored and co-authored 594 articles (source: PubMed), and penned numerous chapters for books, as well as writing his own books, which bears testament to his extensive research activity and creativity.
Walter Hörl was also a brilliant teacher and clinician. Students of the University of Vienna elected him to “teacher of the month and the year” on several occasions and patients came from far to Vienna to receive his invaluable advices.
Walter Hörl was honoured with a great number of awards over the course of his scientific career, including the Nils-Alwall Award, the Addis Award, the International Distinguished Research Medal (National Kidney Foundation, USA) and the Albert Struyvenberg Medal (European Society of Clinical Investigation). He had been a member of the Royal College of Physicians in London (FRCP) since 1998. It was only in the past year that the German Society for Nephrology presented Walter Hörl with the Franz-Volhard Medal, the greatest accolade awarded by the society.
Since 1998 he was editor of the “Nephronews”, which he established and of which he was the “spiritual father”. It has become a highly respected journal in clinical nephrology and education in the German-speaking world.
Walter Hörl has dedicated part of his life to the growth of our Society. He was Council member from 1999 to 2002 and Congress President in 2001.
With the death of Prof. Hörl, the European nephrology has lost an important representative of the field. We would like to offer the family of Walter Hörl our condolences and express our deepest sympathy.
Raymond Vanholder (ERA-EDTA President)
Ziad A. Massy
Gert J. Mayer
Mehmet S. Sever