Jay Ivan Meltzer MD

Meltzer joined the clinic staff full time in 1959 after joining the faculty as a clinical instructor and the hospital as an attending physician. He continued to work in John Laragh’s lab and its clinical unit the “Metabolism Ward,” while in full time clinical practice. Dr. Bradley viewed all kidney disease as Bright’s Disease and worked on its natural history. The only treatment for hypertension was bilateral thoraco-lumbar sympathectomy for malignant hypertension, rawolfia serpentine for the benign form, and finding a “secondary cause”: pheochromocytoma, adrenal tumors and something called unilateral renal disease.

Hemodialysis was in early use for the treatment of acute reversible renal failure, mostly in Europe, and only at Cornell-Bellevue in New York. The most important clinical necessity for the large dialysis centers was triage of the legions of referred renal failure patients between acute, potentially reversible, renal failure and end-stage irreversible disease. The only reliable clinical tool for this critical distinction was renal biopsy, which literally decided life and death. In 1959, Brun and Iversen in Copenhagen used the liver needle with the patient sitting and someone’s fist in the anterior flank to stabilize the biopsied organ. Clinical Nephrology began then. Bright’s Disease disappeared into an organized confusion of new pathologically designated renal diseases, but the scientific basis of a nephrology specialty was stablished.