Laurence Earley, MD

Dr. Laurence Earley came to UCSF in 1968 and as the founding Chief of Nephrology at the Parnassus campus. He left in 1973 to become Chair of Medicine at University of Texas Health Sciences Center in San Antonio. He then served as Chair of Medicine at University of Pennsylvania from 1977-1990. He was President of the American Society of Nephrology from 1977-1978.

On organizing the UCSF Division of Nephrology: When I was there, we organized kidney disease and electrolyte metabolism as a division of the Department of Medicine. Of course there were nephrologists there before making important contributions to both clinical and basic understanding in the area of kidney disease and renal physiology. I was not the first nephrologist.

Isidore Edelman, who supsequently became chairman of biochemistry at Columbia University had been at UCSF, in both the Departments of Medicine and Biochemistry, for a number of years, probably ten years. He had a great interest in nephrology and electrolyte metabolism, and had organized a research and clinical program there as part of the Cardiovascular Research Institute and the Departments of Medicine and Biochemistry.

Dr. Paul Gulyassy, a protégé of Dr. Isadore Edelman, was a clinical nephrologist. He and Dr. Jim Hopper, also a clinical nephrologist, worked as an organized group in the area of nephrology. You have to keep in mind that the term “nephrology” was embryonic at that time. It had only come into general use a few years earlier in the 1960’s. But anyhow, Dr. Hopper spent a year with Professor Hamburger in France, and learned the technique of renal biopsy. And he would have been one of the very early individuals in this country who was skilled at percutaneous renal biopsy.

Dr. Marilyn Farquhar,³ an electron microscopist, was a member of the Department of Anatomy. Dr. Hopper performed renal biopsies on patients with glomerulonephritis and lupus, and other forms of renal disease, Dr. Farquhar did electron microscopies. Together, they amassed quite a collection of electron micrographs of patients with renal disease. Now all of this was done during the 1960’s, before there was an organized division with fellows and administrative responsibilities, and so forth. Also on the faculty prior to my arrival were Dr. Curtis Morris and Dr. Anthony Sebastian.⁴ Their interests were primarily in metabolic disorders of renal tubular function. Together they have made major contributions in this area.

When I came, Dr. Gulyassy joined the faculty the San Francisco General Hospital, and was in charge of organizing the nephrology program there. Dr. Michael Humphreys,⁵ who has supsequently led the nephrology program there, was one of my fellows when I was at Harvard at the Thorndike Laboratories. When I moved to San Francisco he and Terry Daugherty, moved with me, and we also inherited, so to speak, three young fellows, who had been selected by Dr. Edelman before: Henry Grausz, Gary Truex, and Bob Kennedy.

After a couple of years we were able and fortunate to recruit Bob Schrier. Bob was just getting out of the military – the army, I believe. Then I was successful in getting a program project grant and a National Institutes of Health training grant. So we were able to get things into an organized division with support from the National Institutes of Health, and other agencies. So in those early years, there were these faculty members and a small group of fellows. That’s the way we started. When Mike Humphreys completed his training, he joined the faculty also. We sort of were beginning to coalesce into an organized group. Then after about my third year there, we were fortunate to recruit Barry Brenner to head a program over at the Veteran’s Hospital. And Barry Brenner had just finished training with Dr. Robert Berliner at the Laboratory of Kidney and Electrolyte Metabolism at the National Heart Institute. So he went from that role at the NIH directly to the Veteran’s Hospital in San Francisco. So we tried to pull it together into a three-hospital program, with Moffitt, San Francisco General and the Veteran’s Hospital. We had what we would call renal rounds, a multi-hospital renal conference, once a week, and we would rotate that from among the three hospitals, and when I was successful in getting a training grant, we had the training grant include positions, or at least the possibility of positions, for fellows who would train not just at the Moffitt, but with Barry or with Paul Gulyassy over at San Francisco General. So we were trying to work it out into a multi-hospital program.

I want to mention Holly Smith. I think he deserves a great deal of recognition for all aspects of the Department of Medicine, in particular this one. That’s what he envisioned --establishing a nationally recognized division of nephrology. That’s what he wanted, so he supported me all along the way. He recruited me, and he supported the efforts to recruit others and develop the division. So Dr. Smith and those names I’ve given you who were already there, they were the driving forces.

On his research while at UCSF: At that time my research was aimed more at the regulation of sodium excretion, and that’s really what we focused on also when Bob Schrier came. I would say continuing to explore the renal regulation of sodium excretion was our major research thrust. We encouraged continued interest in the electron microscopy of kidney disease through Jim Hopper and his biopsy expertise in the various forms of glomerulonephritis.

We were utilizing clearance techniques primarily, but we subsequently introduced micropuncture at the Moffitt. We recruited an individual from Munich, Germany, Wolf Buentig, and he came with his training in micropuncture.

3. Dr. Marilyn Farquhar has held Professorships at UCSF, Rockefeller, Yale and UC San Diego. She is a member of the National Academy of Sciences and winner of the ASN Homer W. Smith Award (1988)

4. Dr. Curtis Morris and Anthony Sebastian remain at UCSF and were awarded the ASN Belding H. Scribner Award in 2002

5. Dr. Michael Humphreys was Chief of Nephrology at San Francisco General Hospital from 1973-2003 and remains on the faculty