Barry Brenner, MD
Dr. Barry Brenner was founding Chief of Nephrology at the SF Veterans Administration Hospital from 1969-1976. During this time, he conducted groundbreaking work on the mechanisms of glomerular filtration and launched the first edition of the Brenner and Rector's The Kidney, the world’s foremost textbook of nephrology, now in its 8th edition. After UCSF, Dr. Brenner was at the Brigham and Women's Hospital where he was Chief of Nephrology for 22 years. He was president of the American Society of Nephrology in 1986-87.
On his research while at UCSF: The unraveling of the mystery of how the glomerulus worked was the central theme of our time in San Francisco, made possible by the ability to directly study all the forces and flows that govern glomerular filtration in experimental animals, animals with surface glomeruli. So we did what I think are the classic studies on the dynamics of glomerular ultrafiltration. And helping me in the work, not only did I have the benefit of just the very best technician in the world, Julia Troy, the most meticulous clinical chemist imaginable, but young Dr. Terrance Daugharty, who had trained with Larry Earley, who came over to the VA and learned micropuncture; and a number of very talented fellows, including David Maddox, Christine Baylis, and Iekuni Ichikawa, who helped us with these early studies of the glomerulus. And I formed a very powerful working collaboration with Channing Robertson and his chemical engineering students at Stanford: William Deen, Ramsay Chang, and Michael Bohrer, all of whom helped unravel many of the biophysical properties of glomerulus, based on the experimental data we were able to generate in this unique strain of Munich Wistar rats.
So the thrust of the work over the seven years that I was there gave us the opportunity to clearly define ultrafiltration mechanics and then went on and not only looked at how the glomerulus allowed the filtration of salt and water in quantities far in excess of what any other capillary bed could do, but ironically, despite all that high permeability to salt and water, the glomerular capillary, being almost completely restrictive to the movement of macro-molecules, posed the dilemma: how do you have basically an open filtration system for salt and water and a nearly closed filtration system for plasma proteins? Using dextran molecules that were carefully sized, we were able to discover and explore the charge- and size-selective properties of the glomerular capillary wall. Again, with my colleagues in chemical engineering at Stanford, we put together a very rational explanation for this duality of high permeability to small solutes and selective restriction to larger solutes. And I kept taking our studies toward the clinical end. Being trained as a physician, I bent less towards just going on and on with biophysics, but more to steer the research toward a better understanding of the clinical disorders, the abnormalities of filtration and abnormalities of glomerular sieving in the form of proteinuria that we see clinically. Those are the things, I think, that most dramatically characterize what we did in San Francisco.
On the origins of the textbook Brenner and Rector's The Kidney: It all started by a Saturday morning visit that I made to my chief of medicine, Dr. Marvin Sleisenger, at the VA Hospital. When I walked into his office, I saw him pouring over long sheets of galley proof and asked him what they were about. He said it was a new textbook that he was doing in Gastroenterology, Sleisenger and Fortran's, which became a classic in the field. I was so admiring of his ability to do not only his daily job, being a very good chief of medicine, but now taking on this monumental task of trying to encapsulate a huge field of clinical medicine. I said: “You must be so proud to be involved in this,” and he said, without skipping a beat: “Why don’t you do the same thing for the kidney? Why don’t you edit a major textbook of kidney disease, and normal kidney function?” I was so honored by the suggestion, and surprised when three days later, his editor from the W.B. Saunders company, called and asked to come and meet with me and talk about this new textbook he had in mind for the kidney.
I was attracted to the idea but felt it was far too intimidating a project for me to do alone at that early stage in my career. I was only 33 years old! And so I looked around for some suitable co-editor to join me in this, and it turns out that about that time, Floyd Rector was moving to San Francisco, to the University Hospital to be Chief of the Renal Division there. And I had already known Floyd Rector quite well from some collaborations that we had while I was at NIH and he was in Dallas. He agreed to join me. We spent a very productive half an afternoon at my home, mapping out the organization for this new textbook, which was quickly and enthusiastically agreed upon by the Saunders Company, and we were off and running. Three years later, in 1976, the first edition was published and Floyd Rector joined me as a co-editor through the second, third and fourth editions, which came out in four year cycles after the initial one in 1976. And then after that, I edited the book alone until the 8th edition: the 9th, will have five new people join me in this project.
On San Francisco and UCSF: We lived in Mill Valley and had this wonderful, quite glorious commute every day across the Golden Gate Bridge, and this winding road through the Presidio and along the coast to where the VA Hospital sits. It’s called the Ft. Miley area, and very beautiful. I spent many days sitting on a bench overlooking the entrance to the Golden Gate Bridge while having lunch and watching the beautiful parabolic flight of the hummingbirds that populated the trees there on the coast. My children were 13 months old and three months old when we first moved to the Bay area, and fortunately for me, being able to get as much work done as I did, was that I had this very supportive and enabling wife, Jane, who was home with the children. So we were able to raise two great kids in a very beautiful place in Mill Valley, and I was still able to be a busy guy, working six and a half days a week.
I think the history of the Nephrology program at UCSF is very rich. There was Izzy Edelman1 and Paul Gulyassy,2 both very distinguished in nephrology, who had been there for many years. So the program was not a formal nephrology training program until Larry Earley and I got there. Larry Earley preceded me by two or three years. And then there was Bob Schrier, and Floyd Rector coming. There were also very distinguished future leaders in Nephrology emerging from the local scene. Michael Humphreys, who trained with Larry Earley, was now over at the San Francisco General Hospital, where he along with Paul Gulyassy were running very good divisions and developing training programs as well. It didn’t take long for the programs from the VA, University Hospital and the San Francisco General to sit down and work out a fine program which we called, the Unified Program in Nephrology for UCSF generally. And I had the pleasure of chairing the training program for the combined structure, and we interviewed candidates for fellowship in a joint way, and we had rotations that were joint, and we had quarterly dinners each year. These UPIN dinners would bring some national or international luminary to be a speaker and visiting professor, and we brought in all of the academic and nonacademic affiliated nephrologists from town and fill a room with 50 or 60 physicians interested in nephrology for these programs. So it was very rich. And frankly, when I moved to Boston, I patterned much of the structure of the academic training program on what had evolved in San Francisco. So I believe the training program and the staff in San Francisco ranked and still ranks among the very best developed in the past 50 years anywhere. And for that reason, I applaud your putting together this history to try to recall the good things that happened there.
1. Dr. Isadore (Izzy) Edelman was Chief of Medical Service at San Francisco General Hospital as well as Professor of Medicine and Physiology and Professor of Biophysics at UCSF (please see http://www.nature.com/ki/journal/v56/n5/pdf/4491124a.pdf).
2. Dr. Paul Gulyassy was Chief of Nephrology at San Francisco General Hospital from 1968-1972 and then Chief of Nephrology at University of California, Davis from 1972- 1991.