HISTORY OF THE NEPHROLOGY DIVISION AT THE ROYAL VICTORIA HOSPITAL IN MONTREAL

by Mortimer Levy, M.D.

The Royal Victoria Hospital of the McGill University Health Centre (MUHC) has been a leader in nephrological care since 1948 when it introduced hemodialysis for acute renal failure to Montreal. It also has one of the earliest transplant programs in Canada, and has pioneered self-care hemodialysis. Although talented and interested internists such as Dr. Walter Scriver and Dr. Martin Hoffman cared for those patients with nephrological problems in the 1940's and 1950's, it was not until approximately 1957 with the arrival of Dr. Robert O. Morgan that the Royal Victoria Hospital had its first physician trained to be a nephrologist.

Upon his arrival, Dr. Morgan took over operation of the rotating drum kidney (which had been sent in 1948 to the Royal Victoria Hospital by Dr. Wilhelm Kolff), and was able to treat patients with acute renal failure effectively. He also established the clinical Nephrology Laboratory, which was one of the few laboratories anywhere existing as a discrete operating unit, and offering a comprehensive array of nephrological tests. During the 1960's this laboratory offered measurements of creatinine clearance, inulin clearance, PAH clearance, as well as the more usual microscopic urinalysis, protein determinations, drug intoxication screening, kidney stone analysis, osmolality, and a variety of other tests. This clinical Nephrology Laboratory is operating today within the context of the Biochemistry Laboratory, and offers a complete list of services.

Dr. Morgan left for the U.S.A. in 1962, and was replaced by Dr. John B. Dossetor, who established the first transplant program at McGill University, and one of the first in Canada. Although kidney transplantation between identical twins had been performed in 1958, a regular cadaver kidney transplant program began only in 1964. Initially, a small two unit hemodialysis centre cared for those patients who were destined to be transplanted, but in 1968, the Royal Victoria Hospital established a small four or five unit dialysis centre, which cared for 14 patients with chronic renal failure, whether or not they were destined to receive a kidney transplant. This has now grown to a 26 unit centre which at any given time cares for approximately 150 patients (three shifts, six days per week).

In September 1965, Dr. John Dirks arrived at the Royal Victoria Hospital fresh from a three year training period in kidney physiology and micropuncture at the National Institutes of Health in Bethesda, Maryland, under the supervision of Dr. Robert Berliner. Nephrological activities were now divided into a medical Nephrology Division under the supervision of Dr. Dirks, and a Renal Transplant Unit under the supervision of Dr. John Dossetor, who left McGill University in 1969, and was replaced a year later by Dr. Ron Guttmann. The 1970's saw rapid growth in all areas with as many as 10 or 11 nephrologists at one point offering a wide variety of services. From 1976 to 1984, the Nephrology Division was led by Dr. John Seely, and from 1984 to 1998 by Dr. Mortimer Levy.

In addition to the hemodialysis centre, there is an active continuous ambulatory peritoneal dialysis unit (established in 1980). The Transplant Program has also blossomed, and is under the leadership of Dr. Marcelo Cantarovich since 2003. Approximately 100 kidney transplants are performed every year. Four transplant-oriented nephrologists care for the kidney transplant patients on an indoor basis, in collaboration with the surgical team. Five transplant nephrologists care for patients in the outpatient clinic setting.

Since 1998, the MUHC Nephrology Division is led by Dr. Andrey Cybulsky, and includes a team of nephrologists working at the Montreal General Hospital and at the Royal Victoria Hospital. The nephrologists at the Montreal General Hospital also have links with two satellite hemodialysis units in northern Quebec.

Today, in addition to an active indoor consultation and kidney transplant program, a busy clinic offers outpatient consultation two mornings per week, a chronic renal insufficiency clinic administers to patients who are in the predialysis (or pretransplant) phase of their kidney disease, and a kidney transplant clinic provides services to patients who received transplants. Several members of the Nephrology Division carry out active research programs, and more information concerning these may be seen on their individual links.