The MGH Bulfinch Building and Harvard Medical School, c.1856

History of the Nephrology Division at Massachusetts General Hospital

Until the 1960's there was no clearly named area of medical practice or research relating specifically to kidney function and disease. Although the term nephrologie appeared early in the 19th century, it was rarely used, and it referred to the study of the anatomy of the kidney. There were no Nephrology Divisions or nephrologists until about 1960, when the International Society of Nephrology was founded and met at Evian. When the third International Congress of Nephrology was held in Washington D.C. in 1966, it was under the sponsorship of the Renal Section, of the American Heart Association. It was not until 1967 that the American Society of Nephrology had its initial meeting in Los Angeles.

So when Alex Leaf returned to the Massachusetts General Hospital in 1949, after residency at Mayo, there was no Nephrology Division and there were no nephrologists. The study of physiology and diseases involving fluids and electrolytes and kidney function was, for the most part, included under "Metabolism" and in this hospital, was the province of the renowned physician Fuller Albright, who at that time was involved in study of calcium and phosphorus metabolism, bone disease and the parathyroids. Alex Leaf joined Albright as a fellow in 1949. In 1950, he set up his own small lab with a rat bio-assay for anti-diuretic hormone. He soon had two fellows working with him, Audley Mamby and Oliver Wrong. Their studies chiefly involved regulation of body fluids and renal excretion of water and sodium. In 1953 they moved to the third floor of the Domestic building, and were joined by E.P. Tuttle and Walter Kerr.

In 1954, Leaf spent 4 months in Copenhagen in the laboratory of Hans Ussing, and in 1955 he began two years in Oxford in the laboratory of professor Hans Krebs. Returning to MGH in 1957, he was appointed chief of the new Cardiorenal Laboratories. Dr. Leaf's group continued their studies of membrane transport, and antidiuretic hormone and aldosterone action and were joined by biochemist, Dr. Geoffrey Sharp. Howard Frazier was also actively involved in activities of the Cardiorenal Division. A number of fellows were present during the next years, including Norman Lichtenstein and Cecil Coggins. The group served the hospital as consultants for patients with kidney disease or disorders of fluid and electrolyte metabolism and assisted in teaching the Harvard Medical School students. Donald Dibona, a Ph.D. in Biophysics, joined the group.

During the 1960's, both renal transplantation and hemodialysis were coming of age. Leaf decided not to invest heavily in hemodialysis, especially when the Brigham had a very active program, but agreed that the surgical services needed a dialysis unit to support their transplantation efforts. A Dialysis Unit was therefore set up under the Department of Surgery, but staffed by members of the Medical Services. George Baker was the first director, and was later followed by Clyde Beck, and then by Nina Tolkoff (-Rubin).

Lot Page (of the Endocrine Unit) and Frazier had performed a few closed kidney biopsies, and Coggins reintroduced the technique, beginning an active collaboration with Robert McCluskey, Robert Colvin, and Vivian Pinn of Pathology.

In 1967 when the Nephrology Division moved to the 7th floor of the new Jackson building, Leaf had been appointed Chief of Medicine. The Division was divided into a Clinical Nephrology Division, directed by Samuel Thier, a Biochemical Pharmacology research activity directed by Geoff Sharp, and Renal Biophysics directed by Dibona and Leaf. Sam Thier departed to become Associate Chief of Medicine with Arnold Relman, at the University of Pennsylvania, Chief of Medicine at Yale and then President of Partners Healthcare Inc., and Coggins took over as acting Clinical Chief, assisted by Norm Lichtenstein and Nina Tolkoff (-Rubin). Geoff Sharp departed to Tufts and then to Cornell in the 1970s and Dibona moved south, becoming a Professor at the University of Alabama, and then Chairman of Anatomy in South Carolina. He was replaced by John Mills in the Laboratory of Renal Biophysics.

On stepping down as chief of the Medical Services, Leaf returned to the Nephrology Division in May of 1981, to reassume the position of Chief of the Nephrology Division. Coggins remained Director of Clinical Nephrology. In 1984, Alex stepped down to become Professor of Preventive Medicine and Epidemiology; and Dennis Ausiello, who had been a fellow starting in 1975, became Chief of the Nephrology Division. In the summer of 1988, the bulk of the research laboratories moved to the new MGH facilities at the former Charlestown Navy Yard. In this year, M. Amin Arnaout was recruited from Boston's Childrens Hospital and Brigham & Women's Hospital. In 1991, Dr. Arnaout established the Leukocyte Biology and Inflammation Program at MGH.

In 1995, a portion of the clinical activity of the Nephrology Division moved to new quarters, on the fifth floor of Charles River Plaza. In 1997, we began a formal collaboration with the Renal division of the Brigham & Women's Hospital, under the direction of Dr. Barry M. Brenner, to combine the clinical year of the two fellowship programs. In 1996, Dennis Ausiello was appointed Chief of the Medical Services at the Massachusetts General Hospital, and in July 1998, Dr. M. Amin Arnaout was appointed Chief of the MGH Nephrology Division. In 1997, Dr. Arnaout founded and became the first Director of the MGH Structural Biology Facility.

In addition to the active research programs of the Nephrology Division and the clinical services performed, a large number of renal fellows received their clinical and research training in the MGH Nephrology Division. Many of these have gone on to positions of leadership in the academic, research and clinical fields in the U.S. and in countries throughout the world. -- Cecil Coggins.