ATTN Nephrology Fellows: Origins of Renal Physiology fellows course now open for applications

Jeff during a trip to MDIBL

As a senior resident at the Beth Israel Deaconess Medical Center, I was fortunate enough to have had the opportunity to attend the Mount Desert Island Biological Laboratories even before I knew there a course for Renal fellows. It was there that I learned of the importance of comparative physiology in our understanding of the Renal physiology we see every day as nephrologists. For anyone who has attended the Renal Fellows course at MDIBL, the Animal House region of this year's NephMadness undoubtedly made you smile. In fact, choosing a winner was like picking your favorite child. How could you decide between how toads and camels solve their osmolality problems?! They didn't even mention why seagulls "spit" (they excrete salty fluid that drips onto their beaks...and it flies off when they shake their heads!). See what you're missing?

5 years after my first trip to MDIBL, I have been back every year since, teaching in the BIDMC and Hospitalist courses. But I will always have a special place in my heart for the Renal Fellows course, where I learned more in 1 week about basic science, renal physiology, and how lucky I was to be a future nephrologist than I ever thought. We worked hard...and we played hard. When not in the lab, we were exploring Acadia National Park on foot and on bicycle, eating obscene amounts of shellfish in Bar Harbor, and getting to know our fellow fellows and some of the most influential physician-scientists in the field.

In fact, I loved the course so much that I decided to study it! Here is our published paper about just how great the Renal Fellows course is So here's the deal,...if you want to go, you have to APPLY. Your course tuition is on the house! (the NIDDK is footing the bill). This year, it's happening from August 18th through 25th.

Visit the website for all the detail. Application Deadline is July 30th (Seats fill fast)

If you have questions, please don't hesitate to e-mail me -

Jeffrey William, MD
Instructor of Medicine, Harvard Medical School
Beth Israel Deaconess Medical Center
jhwillia@bidmc.harvard.edu  


 Check out all of the posts about this course on RFN

Origins of Renal Physiology at MDIBL Continues to Inspire Nephrology Fellows

2017 MDIBL Origins of Renal Physiology National Renal Fellows Course

I first discovered the Origins of Renal Physiology course on Renal Fellow Network as a medicine intern, and ever since that time, dreamt of going to the course as a renal fellow. Nate’s picture in front of the “Kidney Shed” was seared in my mind. The dream finally came true two weeks ago when I set foot on the Mount Desert Island Biological Lab (MDIBL) in Coastal Maine, and the first place I visited was indeed the Kidney Shed.

Can't believe I am finally here ! This place is gorgeous!! @Nephro_Sparks @RenalFellowNtwk pic.twitter.com/XgOyShoaQg

— Manasi (@manasib33) August 26, 2017

In his opening address to the fellows attending the course, Dr. Ziedel rightly said “Physiology is the pride of Nephrology”. He went on to mention the names of several luminaries who have worked at the MDIBL leading to many important discoveries. The lab has been a cornerstone of nephrology research and has been a home for the work of Homer Smith, E.K Marshall, David Evans, Franklin Epstein, and many others who have spent years working on and elucidating the fundamental concepts on kidney physiology.

In modern day practice of nephrology, we are less exposed to these fundamentals of kidney physiology that initially piqued our interest in nephrology. The Origins course is one of the many efforts made by the renal community to reconnect nephrolgoy fellows to physiology. It’s a very unique course which gives the fellows an opportunity to rub elbows with senior and distinguished renal physiologists from esteemed institutions and work with them on experiments to understand the different aspects of kidney biology.

The course consisted of 7 modules, each focusing on a functional unit of the nephron- the glomerulus, proximal tubule, thick ascending limb, distal tubule, acid-base, water homeostasis, and chloride secretion. We studied animals like zebrafish, turtles, and toad bladders. We also explored how ENaC and NKCC channels work. We delved into discussion about morpholinos and so much more. Over the duration of the course, we developed a new-found appreciation for the beauty and wonder of exploring how the kidney regulates homeostasis. We also got a sense for the profound impact MDIBL has had on the field of nephrology and physiology.

@NBLUniv alumni reuniting to learn about renal phys and explore beautiful Maine #MDIBL #originsofrenalphysiology #barharbor #renalfellows pic.twitter.com/XireCWFqqU

— Diana Mina (@DiMiRenalMD) September 1, 2017

As MDIBL is in such close proximity to Acadia National Park- one of the most beautiful national parks in the world, nature is inherently embedded in the process of learning here. Most days started off with a refreshing early morning short hike which energized us to spend the entire day in the lab. On alternate days, amazing outdoor activities were planned for us after presentations of the earlier day’s work. My week at the MDIBL during this course was very memorable.

I was honored to be working closely with great mentors and met nephrology fellows from all over the US and abroad, shared interests and future aspirations and found new friends. 

All in all, an incredible experience! I would wholeheartedly endorse this conference for future fellows.

Manasi Bapat
@manasib33
2nd year Nephrology Fellow
Mount Sinai Hospital, NY

Attention Fellows: Attend the Origins of Renal Physiology Fellows Course 2017

The National Course for Renal Fellows: Origins of Renal Physiology (August 27 – September 3, 2017), is filling up fast.

This 1 week course provides a strong foundation in renal physiology for future renal investigators, teachers and clinicians.

Join 28 of your colleagues from around the country at the Mount Desert Island Biological Laboratories for this highly rated, transformational course.

Origins of Renal Physiology is entirely unique among national renal short courses. The course provides participants with research tools that give them a deeper understanding of concepts of physiological homeostasis which is difficult to attain during normal clinical training schedules. In this course, trainees will perform experiments involving both classical physiological models, as well as modern reductionist approaches and confocal microscopy to follow trafficking of transporter proteins in cultured cells. In addition to the curriculum itself, fellows will benefit from close interactions with senior investigators in renal physiology, who will guide them through the performance of the experiments, share meals with them in the dining room, and take the time to discuss their career goals with them. In addition, fellows will benefit enormously by working closely with other fellows from different programs, and sharing their insights into renal research. The course is organized around several laboratory modules and one enrichment module in Responsible Conduct of Research. Participants will complete three of the rotations over the six-day course. The first day of each rotation involves intensive experimental work, and the second day involves analysis and presentation of the work to the entire conference group.

Apply here. 

Note: This is a fantastic opportunity. Don't even think twice about it. SIGN UP and GO!!! I would go back in a heartbeat. Matt Sparks (2008 Alum)

Reminder: Attend the Origins of Renal Physiology Fellows Course 2016

National Course for Renal Fellows: Origins of Renal Physiology Applications are now open for this national renal fellows’ course, which runs from August 27 to September 3, 2016 at the Mount Desert Island Biological Laboratories, near Acadia National Park in Maine. Sponsored by ASN and supported by NIH NIDDK, the course offers a week long immersion in renal physiology research. Tuition, room and board are free of charge to trainees. Apply here

Note: I went to the first offering of this course in 2008 and it was AWESOME. Met Nate, got hooked on RFN and the rest is history. You would be a fool for missing this experience. Once in a lifetime chance to learn and network in a very unique environment.

It is FREE by the way. DO IT NOW.  SIGN UP!! Last day to apply is April 30, 2016

Origins of Renal Physiology

Every year we like to publicize the MDIBL origins of renal physiology course. This is a great opportunity for renal fellows and the fact that it is free apart from transportation costs is a huge bonus. This is a message from the course director:

NATIONAL COURSE FOR RENAL FELLOWS: ORIGINS OF RENAL PHYSIOLOGY

THE ASN-Affiliated and NIH sponsored NATIONAL COURSE FOR RENAL FELLOWS: ORIGINS OF RENAL PHYSIOLOGY course welcomes applications from renal fellows.  The one week course (8/31/13 - 9/7/13) provides an intensive hands on laboratory experience which teaches classical physiology coupled to modern cell and systems biology.  The perspectives the course develops are ideally suited both to renal fellows who seek a career in investigation, as well as renal fellows who plan on a career as clinicians or clinician educators.

The course has received absolutely outstanding reviews from all of its trainees, over the past 7 years.  With generous NIH support, the course is offered tuition free, and room and board at the seaside Mount Desert Island Laboratories are also free.  The only cost is transportation to and from Boston; course organizers will help get all trainees between Boston and Maine.

To apply, go to the course website at:  http://www.mdibl.org/courses/Origins_of_Renal_Physiology_Renal_Fellows/114/

We look forward to seeing you there!

All the best,

Mark L. Zeidel, M.D.
Course Director

The Origins of Renal Physiology, a National Course for Renal Fellows

This fall I attended the fourth annual Origins of Renal Physiology course for nephrology fellows at the Mount Desert Island Biological Laboratory (MDIBL). The course was designed to allow fellows an opportunity to connect with the historical roots of renal physiology and to gain perspective through comparative physiology. The founder of this blog, Nathan Hellman, attended the first course and blogged about his experience in 2008.

The course took place on the coast of Maine at the MDIBL, a place with great historical and modern day significance for renal physiology. George Dorr, who founded Acadia National Park with John D. Rockefeller, had the foresight to recognize the potential value of the island for the scientific community. He offered land for two labs, the MDIBL and the Jackson Laboratory (which also continues to operate on the island with tremendous success). The MDIBL is where E. K. Marshall discovered and described active tubular transport in the goosefish in the 1920’s. It is where Homer Smith wrestled with the concepts of clearance, GFR, and effective renal blood flow and worked out calculations based on his studies in marine animals. He did ground breaking experiments in the lab and wrote a number of manuscripts and books in his cottage on the campus describing these fundamental concepts. For 35 years, he spent his summers working at the MDIBL. Roberts Pitts called this time the “Smithian Era of renal physiology”. Homer Smith brought many others to the island to work on renal physiology, and over the years a number of important discoveries have been made at the MDIBL. The lab continues to be a place of excellence, active in research.

The annual course brings fellows back to this historical place and places them under the mentorship of a distinguished faculty. Mark Zeidel serves as the course director and every year he brings in a remarkable faculty from across the country to distill fundamental concepts of renal physiology in a historical and comparative context. They do this by dividing the course up into six modules. Each fellow participates in three of the six modules with each module lasting for two days. The modules split the kidney up into functional units beginning with the glomerulus and continuing on through the proximal tubule, the loop of Henle, and the distal tubule. They also covered salt and water homeostasis and renal genetics. On the first day of each module, we worked with the faculty in the lab performing experiments using classic physiology model systems such as the toad bladder, the shark rectal gland, the zebrafish, and the xenopus oocyte. We developed a presentation based on our experiments to share with the group on the morning of the second day of each module. Even though we only work with three of the modules each year, we learned what the other groups were doing through the peer presentations. The afternoons after the presentations were spent exploring the island and Acadia National Park. There were organized outings for hiking, biking, and kayaking. We finished the week with a big lobster bake at a park on the seawall.

I have had the great pleasure of attending the course each of the last two years, participating in all six modules. I told my wife when I got home each time that I felt like a kid at camp. Only instead of the usual camp games, we were playing with kidneys and urine. These were tremendous experiences that I will carry with me throughout my career in nephrology. It was great to meet and work with faculty and fellows from across the country. I came away with an enhanced understanding of physiology and a renewed enthusiasm for all things renal. As you make your schedules out for next year, I would encourage you to consider setting aside some time to attend next year’s course, September 2-9.

Posted by Michael Hovater MD

MDIBL - ASN reunion

Date for your diary

Dr Zeidel and the MDIBL crew wish to invite all previous attendees to the Second Annual Reunion of the Mount Desert Island Biological Laboratory National Course for Renal Fellows.

This is a great opportunity for anyone attending Kidney Week to catch up and network with former students and faculty of this wonderful course. More information in the course itself can be found here.

The details of the reunion are below:

Friday, November 11, 2011
6:45 p.m. – 7:45 p.m.
Philadelphia Marriott Downtown
Rooms 309/310


This reunion is sponsored by the American Society of Nephrology.

National Course for Renal Fellows: Origins of Renal Physiology September 3-10, 2011

Places are still open for renal fellows to join the Mount Desert Island Biological Laboratories, near Acadia National Park in Maine, for this 1 week course. Taught by nationally prominent renal physiologists (who are also superb teachers), trainees perform classical and cutting edge experiments using mostly marine models, and share their results with each other in joint laboratory meetings. Each trainee participates in three of the seven modules, and hears about all modules at the lab meetings. As a result, trainees develop a thorough understanding of the physiology of the nephron, from the glomerulus through the collecting duct. The course provides researchers with a broad perspective on renal physiology, and, by linking basic physiology to clinical nephrology, helps future educators to become better teachers of clinical nephrology.


The course has run 4 times, and has received extremely favorable reviews from all who have taken it. Nate and Matt both took the course blogged about it here, here and here. For those of you who have not taken the course, you can apply here.

National Course for Renal Fellows; Origins of Renal Physiology

Listen to a podcast from Dr. Mark Zeidel about the Origins of Renal Physiology course at Mount Desert Island held every September in Maine. This course is a great opportunity to learn about renal physiology "hand's on" with world renowned researchers and an even greater opportunity to get to know other fellows from around the country and world. I attended this week long course two years ago with Nate. Many of the attendee's still communicate regularly. The course directors did a great job teaching and keeping the material interesting. Each fellow will get experience in three separate modules focusing on a different segment of the nephron. After a day of experiments and data analysis, the next morning is spent giving presentations about the results obtained. The rest of the day is free to explore the Island. Overall, I thought the course is a unique experience and shouldn't be missed. The course fee continues to drop each year (currently $900- which including food and lodging) and hopefully, as Dr. Zeidel explains in the podcast, the fee might be reduced to free in years to come.

Surviving lactic acidosis; lessons from turtles

Lactic acidosis is frequently seen in the hospital setting. Diverse etiologies account for the accumulation of lactic acid as reviewed by Nathan last year. The main impetus for the production of lactate is having a hypoxic state either in the entire organism, the cellular level or an isolated vascular bed. Most cells in the body break down glucose to form water and carbon dioxide. This is a two-step process. First, glucose is broken down to pyruvate through glycolysis. Then, mitochondria oxidize the pyruvate into water and carbon dioxide by means of the Krebs cycle and oxidative phosphorylation. This second step requires oxygen. The net result is ATP, the energy carrier used by cells. If oxygen supply is inadequate (hypoxia), the mitochondria are unable to continue ATP synthesis at a rate sufficient to supply the cell with the required ATP. In this situation, glycolysis is increased to provide additional ATP, and the excess pyruvate produced is converted into lactate and released from the cell into the bloodstream, where it accumulates over time.

I met Nathan at the Origin's of Renal Physiology Course at Mount Desert Island, Maine a few years ago. This is an outstanding course where you get hands on experience exploring renal physiology using marine life just as Homer Smith did. I remember learning that the painted turtle, Chrysemys picta is able to survive extreme lactic acidosis. As a renal fellow we are frequently consulted for this devastating entity. Unfortunately, we are mostly unable to intervene as the answer in a majority of these cases is to correct the underlying problem. Interestingly, many aquatic vertebrates can remain submerged underwater for remarkably long periods of time. A prime example is the painted turtle, Chriysemys picta, a freshwater species found in Canada and the U.S. Its natural winter habit is to continuously submerge itself in ice-covered ponds for months. The turtle is able to sustain vital organ function for long periods of time despite severely hypoxic or even anoxic conditions. Lab studies have shown that these turtles an fully recover for submergences lasting 3 months at 3 C. The plasma concentration of lactate have been measured as high at 200mM. How is this possible?

The turtle has adapted to this environment by using several unique mechanisms. First, the major extracellular buffer, bicarbonate, is particularly high at baseline (40 mM) in the plasma as well as the peritoneal fluid (80 mM) and pericardial fluid (120 mM). This however, does not account for all of the buffering capacity needed to sustained such profound acidosis. The second and most interesting mechanism is its use of is bone-like shell. The shell accounts for 32% of the turtles total body mass. The portion of its skeleton not incorporated into the shell represents an additional 5.5%. Besides the obvious role it plays as a protective armor, the turtle's shell is also the major mineral reservoir for the body. Over 99% of the total body calcium, magnesium and phosphate and 60% of the body's sodium reside in the shell and bone.

Two mechanisms account for the shells buffering of lactate. First, supplemental buffers are released from the shell directly when needed. During periods of extreme anoxia. Plasma levels of calcium and magnesium increase dramatically. Likely, this is a passive process by which the shell is demineralized by acids. Mainly, calcium carbonate is released. So much calcium is sequestered in the shell that little loss is evident even with prolonged periods of acidosis. A similar process occurs during untreated acidosis in CKD. However, the calcium stores are not quite as profound in the human body. The second mechanism involves the uptake on lactate and a proton directly by the shell. The enormous buffering capacity of the shell allows for this.

Chriysemys picta's unique habit of hibernating during the winter months have allowed for this interesting ability to survive profound lactic acidosis by using its shell as a buffer. Unfortunately, lactic acidosis in the hospital setting is typically extremely difficult to control as the buffering capacity of the body cannot tolerate lactate accumulation for an extended period of time. Research performed on marine life, like at Mount Desert Island, allow for the discovery of novel and interesting ways to survive extremes in physiology.

Major Plug for MDIBL Origins of Renal Physiology Course

Today wrapped up the inaugural Origins of Renal Physiology course at Mount Desert Island Biological Laboratory. It's the first time this has been tried, and though there was significant uncertainty in my mind about what the course would entail, I am really glad that I had participated and I feel most consider it a definite success. I would highly recommend this course to other renal fellows--both those who are interested in a career in research as well as those with a more clinical bent.

In summary, the course included 6 modules on core topics in renal physiology, which included The Glomerulus, the Proximal Tubule, the Thick Ascending Limb, Understanding ENac, Water Metabolism, and (my personal favorite) a module on Salt Secretion using the shark rectal gland as a model system (allowing me to wrestle with an actual shark, as shown above). Each module is headed by a scientist (some nephrologists, some PhDs) with a special expertise in that area, and small groups are given the opportunity to design and carry out their own experiments. Each module was well-organized and in most cases, post-docs or lab technicians were readily available to help carry out experiments on a practical level. Every other day there is a large group meeting in which each module's renal fellows describes their results in the form of brief presentations.

We worked pretty hard on many of the experiments, staying up well past midnight on some nights, but there is also adequate time allotted for exploring the amazing Maine outdoors. The lab is situated within a few miles of Acadia National Forest, and every other day there is some type of group outing planned, such as hiking, biking, or kayaking. This was a fantastic experience.

What the killifish can teach nephrologists

Killifish are small, brightly-colored tropical fish which number well over a thousand different species. What makes them of interest to renal physiologists is their ability to adapt to both freshwater AND saltwater.

It's not a trivial accomplishment: when swimming in fresh water, killifish are severely hypertonic relative to their environment. As a result they make use of apical placement of sodium transporters (such as the loop-sensitive Na-K-2Cl transporter and the thiazide-sensitive Na-Cl transporter) in their gut and their gills, so as to absorb what little sodium that comes into their diet.

In marked contrast, when killifish make their way into salt water, they rapidly switch molecular gears, dramatically increasing expression of the Na-K-2Cl transporter on the BASOLATERAL surface of their gills--thereby turning these organs into a potent salt secreting mechanism.

Killifish successfully make use of their osmotic flexibility by residing in any number of habitats, including river estuaries where fresh water rivers meet the ocean--an area where there can be variable mixing of salt and fresh water.

Phosphate Transporters in the Proximal Tubule

Phosphorus handling is a hot topic in renal physiology, especially considering the advanced being made in bone metabolism suggesting that vascular calcifications may play some role in the high mortality rate of chronic kidney disease patients. But how is it regulated at a molecular level?

The predominant phosphorus uptake channel in the proximal tubule is Napi channel, a Na-phosphorus cotransporter. Its regulation appears to be largely due to regulated trafficking. At basal conditions, the transporter is expressed on the apical surface of proximal tubule cells. However, when the cell receives signals from either PTH or FGF23 (which are secreted in response to elevated phosphorus levels), it will internalize Napi via clathrin-coated pits and it will ultimately be degraded; ultimately this will lead to decreased renal phosphorus reabsorption and a gradual decrease in phosphorus levels.

Zebrafish Glomerular Experiments

The zebrafish kidney is being increasingly studied, as it appears to offer several advantages for studying renal function. For one, it is transparent, allowing one to visualize kidney development in real-time. Second, it is a simplified system consisting of a single glomerulus with two tubules which nonetheless appear to have proximal and distal segments similar to the mammalian kidney. Its large number of offspring produced make it ideal for genetics as well. Finally, it has also been successfully shown to be a model for various disease states, such as polycystic kidney disease, nephrotic syndrome, and aminoglycoside-induced renal failure.

Over the past few days at the MDIBL "Origins of Renal Physiology" course, we have been conducting experiments with zebrafish glomerular filtration. To begin with, we exposed fish to puromycin, a drug known to directly cause podocyte injury (zebrafish are already known to have podocytes). Then, fish were injected with a fluorescently-labeled dextran with a molecular weight of 70kD. Over the next several days, we looked at the rate of disappearance of immunofluorescence, a marker for dextran clearance. Fish untreated with puromycin showed a relatively constant fluorescence--indicating that an intact filtration barrier does not allow 70kD molecules to pass through it. However, fish treated with puromycin showed a dramatic decrease in immunofluorescence--indicating that the podocyte damage induced by puromycin allowed the 70kD dextran to pass through the filtration barrier.

From Fish To Philosopher

Homer Smith is considered the Father of Renal Physiology. He was a PhD (rather than an MD) whose studies on the fish renal system are amongst the first renal physiology experiments. For instance, his work on the goosefish (the funny-lookin' fish pictured to the left), which is aglomerular and therefore relies purely on tubular function for clearance, helped establish the important concepts of secretion and reabsorption as fundamental processes of renal function. Much of his work was done here at Mount Desert Island Biological Laboratory, in a small building right by the ocean called "The Kidney Shed."

Nearby the "Kidney Shed" there is a cute, cell biology-themed fence--which incorporates not only a membrane phospholipid bilayer, but also the Na-K ATPase (in my mind, one of the defining molecules of Nephrology) and the endothelin receptor (complete with 7 transmembrane-spanning segments!)