The early days of nephrology in Colombia
Authors: Saulo Klahr
Journal: Kidney International (2006)

In 1951, Dr Jaime Borrero Ramírez, an intern in medicine at the old Hospital San Vincente de Paúl in Medellín, Colombia, was attending rounds with his professor. They stopped by the bed of a patient exhibiting signs of advanced kidney disease, including uremic frost. In Colombia, in those early years, there was no treatment for this disease. It was only in 1950 that renal biopsies had first been performed in Cali by the Bolivian urologist Lupi Mendoza. That patient examined by Dr Borrero ultimately died. The findings on autopsy revealed sclerotic kidneys and dilated tubules. The plight of such a patient was so disturbing to Dr Borrero that he decided to make the study of renal disease his life's work. He became an eminent nephrologist and, as is detailed below, served from 1970 to 1972 as the second president of the Colombian Society of Nephrology. Nephrology as a specialty in Colombia began in the late 1950s when a series of lectures at the Shaio Fundación in Bogotá were presented by the renowned Dutch specialist Dr Wilhelm Kolff, who had developed the equipment and techniques for peritoneal dialysis and hemodialysis. Dr Kolff's extraordinary presence in Colombia and the knowledge he shared with the physicians there resulted in the desire of several of the Colombian physicians to travel to England and the United States to specialize in this new field. José Mora, who trained with Dr Kolff at the Cleveland Clinic Foundation, returned to Colombia in 1962 and began a nephrology service associated with the Shaio Fundación. Another associate at the Shaio Fundación, a physician who had just returned from five years of training in cardiology at the University of Paris, was Samuel Klahr. He thought nephrology was a promising and exciting specialty, and he urged his younger brother, Saulo, a recent graduate of the Universidad Nacional de Colombia School of Medicine in Bogotá, to seek a fellowship in this field. I had just completed my residency in medicine at the Universidad del Valle School of Medicine in my hometown, Cali, Colombia, and had been named a Special Scholar of the Colombian Institute of Specialization Abroad; this scholarship included a stipend of the grand sum of US$1500 per year for two years. While taking a graduate course in physiology, I was further impressed by lectures on kidney research by a professor who had just come back to Colombia from Harvard University, where he had worked with Dr John Peppenheimer. Formulating my next plan to study the kidneys proved difficult, as I was told there were no clinical residencies in nephrology anywhere! At the medical school library, I happened to see a brochure from the American Heart Association, listing the top cardiologists in the United States. I wrote to Dr John Smith, chief of cardiology at Washington University in St. Louis. Dr Smith advised me to train with Dr Neal Bricker, who had founded the Renal Division at Washington University in 1956. And so, in 1961, I left Colombia and joined the Renal Division at Washington University School of Medicine in St. Louis. When I returned to Colombia in 1966, I had already published ten scientific papers from my work with Dr Bricker. I settled in Cali, where I was appointed associate professor of medicine at the Universidad del Valle School of Medicine. A group of physicians in the new specialty devised and conducted studies at the Rockefeller Research Unit in Cali. My colleagues included K Tripathy (who was also the administrative director of the unit), J Ghitis, FT Garcia, LG Mayoral, O Bolaños and H Lotero. We published several papers on renal function in malnutrition, as well as others on the differential absorption of heme and globin moieties of hemoglobin, and on the qualitative and quantitative analysis of urinary lipids in the nephrotic syndrome. Three fellow nephrologists and I traveled to Washington DC in 1966 to attend the Third World Congress in Nephrology, where I was honored to present a scientific paper. Colombian physicians were beginning to be acknowledged in the United States. In 1966, eight Colombian nephrologists met at the Hospital San Juan de Dios in Bogotá. At this meeting, the Colombian Society of Nephrology was founded. It was quite an extraordinary undertaking by so few enthusiasts. The charter members of this new society were Jaime Borrero, Andrés Revollo, Alvaro Toro, Enrique Carvajal, José Mora, Edgar Sanclemente, Hernán Torres and myself. To celebrate this historic occasion, the eight of us went out to dinner at the Restaurante Salinas. It is worth noting that only the nephrology societies of Brazil, Argentina and Chile predate this Colombian society (Table 1) and that the American Society of Nephrology was organized sometime later.Table 1The presidents of the Colombian Society of Nephrology from its inception to the presentEnrique Carajal1968–1970Jaime Borrero1970–1972José Mora1972–1974Roso Alfredo Cala1974–1976Hernán Torres1976–1978Jorge Luis Arango1978–1980Andrés Revollo1980–1982Alberto Carreño1982–1984Alvaro Mercado1984–1986Eduardo Carrizosa1986–1988Mario Arbeláez1988–1990Roberto D'Achiardi1990–1992Germán Gamarra1992–1994Francisco Barreto1994–1996Gonzalo Mejía1996–1998Hernando Altahona1998–2000Cristobal Buitrago2000–2002Adolfo Pertuz2002–2004Alvaro Garcia2004–2006 Open table in a new tab In Colombia, both pediatric and adult nephrology developed at the same time. The first pediatric nephrologist, Jorge de La Cruz, began his practice at the Hospital Militar de Bogotá in 1961 after training with Dr Guillermo Gordillo at Children's Hospital in Mexico. Later, Dr Erika Cuervo also trained with Dr Gordillo. After studying for two years in Boston, a Medellín physician, Dr Vilma Piedrahita, returned to join the nephrology staff at Hospital San Vincente de Paúl in 1967. During the 1970s other Colombian physicians returned as pediatric nephrologists after training in the United States at renal centers as diverse as the University of Colorado in Denver and the University of Rochester in New York. In 1992, there were 24 pediatric nephrologists in Colombia, most practicing in the larger cities of Bogotá, Medellín, and Cali. I returned to St. Louis in 1967 as assistant professor in medicine at the Renal Division at Washington University School of Medicine. I was promoted to full professor and appointed director of the division in 1972 when Dr Bricker left St. Louis to become the chair of medicine at the Albert Einstein College of Medicine in New York. Several Colombian physicians who trained with me in St. Louis during the 19 years I served as director of the Renal Division have played a role in the development of nephrology in Colombia. Two of the most outstanding fellows of the division, Hector J Rodriguez and Alvaro Mercado, coauthored the first report on the effects of phosphate depletion and parathyroid hormone on renal glucose reabsorption, published in the American Journal of Physiology.1.Harter H.R. Mercado A. Rutherford W.E. et al.Effects of phosphate depletion and parathyroid hormone on renal glucose reabsorption.Am J Physiol. 1974; 227: 1422-1427PubMed Google Scholar Dr Mercado returned to Colombia to serve as director of the Renal Division in Cali. In December 1981, Mercado was finally able to realize an old aspiration to establish the first kidney transplant group in southwestern Colombia. He became the ninth president of the Colombian Society of Nephrology and served as rector of the Universidad del Valle School of Medicine in Cali. From 1980 to 1982, Mario Arbeláez was a fellow in the Renal Division at Washington University. His eight publications focused on the role of parathyroid hormone in uremia. After he returned to Colombia, he developed what has become the largest transplant unit in the country. He also served as president of the Colombian Society of Nephrology from 1988 to 1990. During my tenure as director of the Renal Division, my nephew Enrique Klahr, the son of Samuel Klahr, the brother who, in 1961, had called my attention to the new field of nephrology, spent several months with me training in renal medicine. Enrique is now practicing in two renal centers in Medellín. The Klahr legacy in Colombian nephrology has kept step with the formation and development of the specialty itself, and this is a source of great pride to our family name. The first educational institution for the study of nephrology in Colombia was opened in Bogotá in 1973 at the Universidad Militar Nueva Granada and the Hospital Militar Central. Four more training centers were established during the next two decades. Dr Borrero created a program in Medellín at the Universidad de Antioquia and the Hospital San Vincente de Paúl in 1975. A program was started at the Universidad del Rosario and the Hospital de San José in 1981; Alvaro Mercado founded another at the Hospital Universitario del Valle in Cali in 1984; and finally, a program was established at the Universidad Javeriana and the Hospital de San Ignacio in 1988. Sixty-four nephrologists were graduates of these five centers, and by the end of the century there were about 90 renal specialists in Colombia. Additional renal divisions became part of the growing number of medical schools. Today there are 32 medical schools in Colombia. As a specialty, nephrology continues its advances and widens its scope far beyond any envisioned by Dr Kolff or by Dr Mora. As a Colombian physician who, in 1961, thought the study of renal medicine would be rewarding, I can declare with certainty that this field has provided more rewards than I could ever have imagined. Nephrology has given me a career I love and always find exciting. I have been privileged to teach brilliant students, many of them fellow Colombians, with whom I have been able to share my knowledge and passion, and they in turn have made substantial strides in bringing nephrology to its prominence in Colombia today.