ISN VIDEO LEGACY PROJECT

DR. KLAUS THURAU
INTERVIEWED BY DR. JURGEN SCHNERMANN


JS:

I am in the office of Professor Klaus Thurau in the Department of Physiology of the University of the Bavaria capitol of Munich. The occasion is to interview Professor Thurau in connection with the legacy of the International Society of Nephrology. As someone who has trained and worked with Professor Thurau, it is a great pleasure to do this. Letís being by exploring your education background, Klaus, why did you study medicine among all the other possibilities?

KT:

As often in life, it was a happy coincidence. When I was at a very young age, about 16, 17 years old, I met, in this small place in North Germany where the family lived after the war, a highly intelligent and educated medical doctor. Often at this age, itís the personality which impresses you and gives you some direction for your future life. I think that was really the starting point of getting interested in medicine. So it was logical consequence, and then after I finished high school that I went to the medical school in ?Elamein first and continued in Kiev.

JS:

So I assume that when you first went to medical school that you first planned to be a doctor. Why did you then switch over to look for a career in physiology?

KT:

As a medical student you never plan to be a physiologist. I certainly was more interested to become a surgeon at that time. Before going to a surgical department I decided to go first into a department of physiology or chemistry. In any case, to get some scientific background on which you then can develop an academic career planned in surgery. So it happened that I decided, after the medical school, to join the department of physiology in Gutenham. The director of that department was Professor Kramer and it was the exposure to that unique man and the joy I had doing research that I finally decided not to go back to the medical department of surgery but to continue in physiology. The original plan was for two years and it became a lifelong entertainment.

JS:

So you never ever practiced medicine. There must have been something very convincing about Kramer. What was it that was so extraordinary about this man?

KT:

First, there was his enormous potentiality as a scientist; he had a broad interest in many areas of physiology. Not restricted only to the kidney blood analysis and other areas but also circulation, blood analysis and other areas. I think what fascinated not only me, but many of my colleagues working with him at the time, was his stimulating and intellectual approach to science. He was so proud of everyone who came up with new ideas. He never was jealous about great ideas that others had developed. He was an educated man and an expert in literature and music, two aspects which also fascinated a young man working with an older colleague. I think it was this atmosphere, which Kramer created, which made it so fascinated and so attractive to work with him, and I should say that over the years we became very close personal friends and I think it was one of the greatest things in my life to have such a friend.

JS:

Kramer also apparently was extremely willing to share anything he experienced with people around him. Can you recall special events or things he initiated that are totally specifically Kramer?

KT:

I think one should know that Kramer, after the war, was for three years in the United States working in physiology and returned first to the chair of physiology to ?Marduke and took over the department of physiology in Gurtingham. He brought a very international flair to Gurtingham and one occasion I remember very well, when he was organizing, I think that was one of the first symposia after the war, in physiology, in Germany, that he arranged as a person, which brought together scientists like Heinrich Wirtz, Carl Gottschaik, John Tutenheimer. It was one of these great events specifically to expose young people and young fellows in the department to be exposed to these giants in science. I think that it was one of the greatest things. Kramer always tried to expose the younger scientists to the experts and really great scientists internationally-wise.

JS:

And John Boylan, right?

KT:

John Boylan is a very special case. John Boylan came to Kramer on a sabbatical to Gurtingham and became a very, very close friend of Kramer, which lasted all his life. John Boylan was the idea counterpart to Kramer because he was so interested in literature and music too, so that Kramer could really enjoy talks and discussions and evenings with John Boyland. It was, for us, one of the greatest things to be among these two people and learn and experience their competence

JS:

It is often said part of the attraction of the Gurtingham Institute was its social life and that the soul of it was good Kramer. Kramer put it all together in one scientific context.

KT:

Oh definitely. One of the greatest things which he was so proud of was the carnival, Faschingstein, to have all the members of the department with students and students from outside the department one of the greatest festivals and feasts. We changed the department into a club. It was fascinating to see Kramer among this group of youngsters and enjoying social interaction with everybody. He also was extremely effective in helping people in the department, so he looked after the individuals very carefully and gave his help whenever it was needed.

JS:

So letís turn to your career in physiology. I had the impression that career progressed very rapidly; you started in about í59, when I came to your lab in í63, you were a made-man as one would say. Why do you think you were so successful so fast?

KT:

Well I think that one attractive aspect was that we had been working on our forefront topic in renal physiology in general, and that was the analysis of renal hemodynamics and the inter-renal distribution of renal circulation, not much known at that time about these different areas in the kidney, how they are profused with blood, and what the function of the blood flow around these areas is. Second, in í59 I went to the United States to Washington and worked in ?Waterweed Institute of Research for two years, and at that time I was exposed to many, many colleagues in the United States with whom I established friendships and scientific interactions. These two things, working in an attractive field of physiology and having international experience helped very much in my own career. In Germany it was not questioned at that time, there was an enormous need, Germany, for scientists so the positions became available and developed to develop home research and home research group. These are the major factors in promoting my own career.

JS:

You obviously were interesting in maintain and seeking international connections. Why was that so important to you?

KT:

I think science, in general, is an international affair. Regional science as it was experienced in former times, in countries which were not open to the world, were a bad example for science, how to develop science, how to promote science, so the international aspect in science was, from the beginning on, I was extremely interested in. Specifically, to be exposed and to become friends with very important scientists at that time, I just should mention a few names with whom I became very close. It was Don Seldin, Gergicht, ?Flightrector, Selcourt, Kelkorschelt, Gurtz, DeWardener and that exposure to these excellent scientists immediately helps your own science very much because you measure your own science on the science of those very successful and productive scientists. The internationality of science was for my whole life one of the major driving forces behind my whole career and my own activities.

JS:

Itís my impression that knowledge about kidney function both in basic science as well as clinically has developed extremely rapidly in the Ď50s and early Ď60s. Why do you think that happened at that time? Was it a coincidence between massed availability and the right people? Why do you think so much was done in that time period?

KT:

Well I think youíre right. The availability of new techniques beyond clearance techniques as in the time of Homer Smith pushed enormously. Which was the most used technique in those days to analyze intrarenal functional pattern, in the different segments of the nephron, in the control of reabsorbtion, in the control of circulation. So I think, as quite often in the biological science field, itís a methodology which pushes and opens up new insight into systems. No question that this technique has been picked up by many, many extremely competent scientists in the United States, in France, in Japan, in Germany, in Sweden,which in general pushed this field of renal physiology very much and brought it to an international highly recognized scientific field.

JS:

If though, obviously, scientific developments are closely connected, they each happened mainly in the United States and Europe. One wonders if there is a different way that science is done in these two regions of the world.

KT:

I donít think today there is much consectional difference in renal physiology in renal kidney science between these two countries, but after the war of course there was an enormous gap. There was a reason for that gap. I think the United States were fortunate and so far as during the Second World War, science could still develop and scientific activities were supported and young scientists could develop on the shoulder of experience and entirely competent scientists flourished, whereas in Europe in general and particularly in Germany, we had a lack of experienced scientists. Some of them left the country for different reasons, others have died. There was a kind of vacuum in Germany and it took quite a number of years to reestablish background of science. The development of scientists over the years, again, to give the help, and push, and exercise young scientists to further develop this area. So it was a calling when many of us went to the United States because the availability of experienced scientists was much larger than in Germany at that time.

JS:

Was it perhaps also the political will to spend the taxpayersí money on science as evidenced by the establishment of the NIH in the United States as this mega funding agency.

KT:

Funding of biological and medical science in Germany primarily comes from Duetsch Forschekemeinscheift and the Forschekemeinscheift in those days was able to support good science in Germany and there was no real shortage of money at that time, but over the years the situation has changed and particular, in the years of today we have a shortage of money because the limitations of the federal budget also limits the support of the Forschekemeinscheift. University budget had been cut down in the last two year by five to ten percent; all signs of shortage of support from the public. So we are presently experiencing a time of shortage of money for research, which was completely different from the sixties and seventies

JS:

Is there hard evidence that science progression is retarded by the lack of appropriate funding as measured for example in the number of submitted manuscripts?

KT:

Well thatís a very difficult question. For young scientists it is less attractive, in these days of shortage, to join research groups and plan for a lifelong work in science. Itís no question that a similar thing exists in the United States. For example, medical students hardly come to the department of basic science any more because they try to make their living outside of science for obvious reasons.

JS:

Letís turn to your scientific contributions a little. You are known to have initiated the work in the tubular glomerular feedback system maybe that is what you are known most for. How did you come up with that idea?

KT:

As I said before, I had been working initially in the field of renal hemodynamics, also it was very clear to us at that time that one of the effector system in regulating hemodynamics in the smooth muscular vasculature in the kidney, however, the trigger to control the vasculature was not quite clear to us. At the same time, we measured the relationship of renal oxygen consumption to renal function and it became quite clear that the major component for renal oxygen consumption is the active reabsorbtion of tubular fluid, particularly electrolytes. The idea then developed, what balances these two primary functions in the kidney,- that is glomerular filtration and tubular reabsorbtion, so there must be some kind of interaction between these because two parameters in renal function because an overflow of the tubular system ?glomerular filtrate would leave to a loss of volume and vice versa. Itís interesting to go back into literature and it was something that always fascinated me at that time. For example, Brunter Reibach in 1929, Brunter Reibach was a physiologist who developed the ?createnine clearance as a measure for glomerular filtrate. In a short note, in one of his papers, mentioned the idea that because of that huge glomerular filtrate it would be absolutely necessary that any damage to the reabsorbtive capacity of the tubular system would automatically lead to enormous volume loss. So in other words, he also already speculated that any damage or change to the reabsorbtive capacity would have to be paralleled by decrease in glomerular filtration rate to avoid volume loss. Second in the Ď30ís the Belgian pathologist Goormaktig investigated microscopically the juxtaglomerular apparatus. Because of this atomical connection of this little structure between the macula densa segment of the distil tubule and the glomerular anatomical elements, he speculated at that time that perhaps a chemical composition of the fluid passing the macula densa may in some way effect the function of the glomerular system. That was fantastic foresight but at that time could not be investigated experimentally in detail. It was in 1963, at the International Congress in Prague, at a main lecture which I had the privilege to give on renal hemodynamics, that I developed, the idea or the possibility that in part the juxtaglomerular apparatus with its function and its connection with the tubular system and vascular system is a link to interact between tubular system and glomerular system. In other words, to contribute to the balance between these two function of the kidney. It was then in 1964 I spend a healthy year in Chapel Hill, with Carl Gottschalk primarily to write an article for the Green Journal on renal biodynamics, that I used this opportunity to develop the possibility that this juxtaglomerular apparatus is one of the crucial interlinking elements between tubular and vascular function in the kidney. Weeks were left before we turned into Germany and I went to the laboratory of Carl Gottschalk where Margaret Mieill was the expert in micropuncture techniques and we built together a little setup for micropuncture for my own. So to test this hypothesis with a very simple experiment, it was well know that the tubular fluid was low on osmolarity and on sodium chloride concentration. And the concept was that an increase in sodium chloride signal at the macula densa may have a negative effect on the glomerular filtration rate. So what I did is just used a micropuncture pipette and punctured the early distil tubule and injected ?retro, an increase of higher sodium chloride concentration as normally present at the macula densa, to see whether or not the glomerular filtration rate would respond. Now I could not, of course, measure the singular filtration rate of that nephron, but a shutdown would drastically decrease in filtration rate and it should be possible to be observed in the diameter of the belonging proximate tubule. For example, a complete shutdown of glomerular filtration rate would automatically lead to a collapse of the proximal tubule because the remaining tubule fluid would be reabsorbed, no further filtrate is being delivered to the proximal tubule and so the proximo tubule would collapse, and that of course would be seen on surface of the kidney through the microscope. These were the very first experiment and I still have the laboratory of the book where all these documents, all these experiments have been documented, and I think it was a very first successful experiment on March 6th that the proximal tubule really collapsed when the sodium chloride concentration at the macula densa was increased. I took this film from the camera on top of the microscope, went to the drugstore, and was so happy to see these collapsed tubule in reality on film. These were the very first experiments and of course later on this have been much more analyzed in detail and I think weíll come to that a little bit later.

JS:

That was a wonderful bit of work for two weeks. Itís the same meeting, in Prague, was another presentation by Arthur Guyton, who was another major player in this particular field. He addressed also some kind of tubular glomerular feedback system. For historical records, would you say that these two developments have been entirely independent of either Arthur Guyton or your way or each othersí?

KT:

No, they were totally independent. As you know, Arthur Guyden was modeling these systems very successfully and came to the conclusion that more or less the osmolarity at the ?accu fluid was the signal received by the macrodenza. But we had no interaction at that time and the development was completely independent of each other.

JS:

Interesting that it happened at the same time though. The other thing that always intrigued me about your publications and your work was that you came up with this wonderful term ďacute renal successĒ. What is the background of that and when was the term coined and in what context?

KT:

The term ďacute renal successĒ was the result of a most enjoyable and stimulating discussion I had with John Boylan in Buffalo. It was in 1976 I visited John Boylan in Buffalo and we thought it would be wonderful to develop this concept of acute renal failure in terms of saving volume for the organism. As a consequence of the shutdown in the glomerular filtrate as a result of a decrease absorbtive capacity of the tubular system during acute renal failure, we thought that this reflex, this intrarenal reflex, is a lifesaving positive reflex for the survival of human beings undergoing acute renal failure. So we termed this reflex ďacute renal successĒ, the unexpected logic of oliguria in acute renal failure. For a certain period of time I think it was a little classical; you said its still aÖ

JS:

I think itís still a classic.

KT:

The title, no question, may have been a little bit sexy or aÖ

JS:

It sounds to me that the title was first and the paper came second.

KT:

Right, you mean the title was right but not so much the paper. But anyway, that was one of the most enjoyable times with John Boylan together and it really paid off, this visit to him in Buffalo.

JS:

Another thing, you spent a lot of scientific and organizational energy on was to establish the electron probes in Munich and the facility where these experiments were done. Do you still believe in this methodology and what was the major contributions of it?

KT:

Well the first question can be easily answered, I still believe in the method. The method is a highly quantitative method to measure intracellular electrolyte concentrations. The reason why we got interested in this method was around 1970, 1972, the method had been applied primarily in physics and in the analysis of material, of hard concrete material surface analysis but not in biology. And it was Adrian Hawkburn in Iowa who first thought of applying this analysis of biological tissues. I visited him in 1970 or so to see how this method works and what is needed to adjust this method for the analysis of biological tissues. I was very optimistic about how it could be done and I acquired a machine here in Europe. And it took us three years to develop this methodology to the point that intracellular electrolyte concentration in free-stride tissues or slices can be measure. I must acknowledge Dr ?Forasjfalk our major supporting agency. They supported us for three years during the development of that method without any paper which we could publish at that time but they thought, ďOk, we will support themĒ. And they really did that for three years and it took us three years finally to come out 1973 with the first paper on the use of the electron probe for the analysis of intracellular electrolyte concentration. At that time we had two groups in our department who were extremely active in the analysis of trance episerial electrolyte transport and flux rates. This was ?Nigle and ?Dugre and primarily. They were extremely interested to analyze individual cells in those episerial structures concerning their contribution to transepiserial electrolyte flux etc, etc. Because the enormigenity of these cells it was essential to identify and to analyze individual cells. It was only in 1984 or so that we used this method also for analysis in the kidney and you may come that in a moment.

JS:

So addressing these scientific issues in little more general terms, I remember you once told me that if you wanted good science you have to have a good concept and you have to then follow it. Do you still feel strongly about it and it that still a recommendation you would give to people?

KT:

I think thereís no question. You may look at yourself; itís the concept which is important beginning of research. You have to adjust methodology and methods to follow and further analyze a concept, which you had in mind as a major theme of your scientific career. Coming back to the tubular glomerular feedback system, which after you joined our group and developed your own groups and stood in this field for a lifetime, it was the concept which fascinated you, not different methods to be applied to different questions and different issues. But the concept is the beginning of a successful scientific career and what then is needed to adopt and pick up new developments in methodology to further look into the details of the concept. That is very important, I think, the issue of a successful scientific career.

JS:

You have been the leader of a physiology department for many, many years. What were your main priorities in this function as an institute leader?

KT:

Well, different aspects, I always found that a department of that size was a large department. As chairman of that department, you are more than happy to have around you competent scientists who are able to establish their own concepts, their own scientific pathway. I think that was one principle that I tried to follow in that department to let those groups develop on their own. Keep hands over the groups and see that they get enough money and support, but the scientific individual immensely important in this department. Second, I enjoyed tremendously exposure to students. This was one reason that I had the chance to join the Max Clank Institute. I never really was serious about leaving the university because lecturing and teaching and surrounded by students were one of those elements of my life, which really I enjoyed tremendously, which also stimulated me, which was certainly not so much existing at the level of the Max Clank Institute.

JS:

So physiology teaching should not be done by clinicians?

KT:

Well I think the intellect approach to the basis of medicine and that is physiology, biochemistry, hemonology, genetics, should be an element in the education years of students at the beginning to give them the idea and experience that whatever he is doing in medicine is based in those concepts developed in basic science. I am very much for exposing students at the very beginning to basic science.

JS:

Physiology as you of course are aware, physiology as a field and physiology departments as a consequence have had and still do, to some extent, somewhat of an identity crisis. What do you think should the modern physiology take to find an identity?

KT:

It all depends what you summarize under the term physiology. As long as the present in most departments perform science at the molecular and cellular level is coupled and matched and controlled by a functional analysis. In other words, what does it mean when, for example, transfer protein has been changed. Is that effective on the transport system per say as measured under functional conditions? In other words the functional control remains a central issue and so far one should remain very clear about it that departments of physiology should fulfill this role in science. Also they incorporate in their own work, of course, a very forefront medical approaches in biomedical research on the molecular and cellular level

JS:

Should physiology departments remain in the frame of a medical faculty or form they their own entity as happens now?

KT:

That is a critical question. I think that first of all medical students need to be trained in physiology, specifically in the organ function. That is something that requires a department of physiology. When it comes to research it becomes difficult to say whether or not the present research in physiology are directly linked to medical problems thatís a very difficult question. I think the gap between the research done between forefront and the bedside problems is enormous. One of the typical examples is that presently in the field of neuroscience, which is so far in terms of research, so far away from the problems in the neurological departments in the hospital. But this is two farther areas, less probably for the departments of physiology which are concerned with circulatory and vasculature research that remains still a field very much linked to medical problems.

JS:

If you always have been one of the physiologists who had an intense interest in clinical issues, for example it must have been the second or third paper that you and I did together on tubular glomerular feedback that had the clinic research whether data or acute renal failure. Do you think it would be a goal that all physiological knowledge should in some way or other be translatable to the bedside?

KT:

Certainly not all but one or another instance it might have direct impact on problems in the hospital. I mean what you mentioned was the papers, which we together published on the pathogenesis of acute renal failure, where we thought that part of the shutdown of the glomerular filtrate was due to the tubular glomerular feedback mechanism. This was immediately picked up by the clinicians as a possible mechanism to understand the mechanism behind acute renal failure. But looking back today I must say also many, many aspects have been analyzed and we are still very far away from understanding those intrarenal mechanisms which come together to shutdown the kidney and to lead to this reversible acute renal failure. Itís probably still a long way to get a clear picture of the different mechanisms. But it was the beginning of a very close relationship between clinical nephrology in those days. First the first time actually, concept based on physiological functions of the kidney was developed to understand better acute renal failure.

JS:

In a more general framework, where do you see where the future of nephrology is, where is it going, and what is the role of physiology in nephrology.

KT:

What is the future of nephrology? I think one unsolved problem despite an enormous role in activities in analyzing detailed cellular and integrated renal function remains the lack of any cause of treatment of the diseased kidney. So I think this is a goal and something which nephrology must keep in mind that the final answer hopefully one day will come up that the disease kidney can be cured, not only as in these days, pheno-menologically, by transplantation or dialysis, but a cause of treatment of a diseased tubular cell or a vascular cell. And that, we are still far away from that but I think that is, still existing, an enormous challenge for nephrology in the future. The role of physiology in this development or in other similar areas remains to be seen. I think the capability of analyzing functional parameters in the kidney remains topic of renal physiology.

JS:

In this concept of the future of nephrology, physiology has a natural place obviously. So turn out to another issue that of you and the International Society of Nephrology. It struck me that you are the only physiologist, as far as I can tell, who has been a card-carrying physiologist who has been a president of the ISN. What do you think this impact you have and what are the memories are the most vivid in regard to you presidency?

KT:

Itís the first I realized that was the only physiologist as president of ISN. I think one reason was that I had a very close contact to clinical scientists; part of the work that we already discussed which was relevant for nephrologists working at the clinical level. Second, before I became president of ISN I was internationally very active in the science community; I was at the council of the International Union of Physiological science for quite a while. I was chairman of the Renal Commission in this union; I was at the council of the International of Council Scientific Unions, in Paris, which again brought together many, many scientists from different areas and different countries. So to speak the internationality of my work was part of the possible decision that the council of ISN elected then elected me as president of ISN.

JS:

What are the memories that you connect with in that time?

KT:

At that time we had fantastic members of the council. This is a working group which worked on almost a daily basis together. And one man I should mention because he was a great person, a great friend; he was the General Secretary of ISN and that was Claude Amiel, who unfortunately died too early. But Claude was a remarkable person very, very intellectual and also balancing between the different views always expressed in the council, and it was fantastical. The past president at that time was Don Seldin, the upcoming president was Ike Robinson, Bob Schrier was in the council. So in other words I have only great memories of that time and it wasÖ

JS:

The greatest memories must be limited to being the president of the ISN congress.

KT:

Well that was quite a great, great experience. That was in Tokyo in 1990 and we can look over a few pictures. Thatís Claude Amiel addressing the audience; Professor Oshima who was the local president of the Congress in 1990; Ike Robinson who was the incoming president, so from 1990 to 1993. I should mention on colleague in Tokyo who helped me personally and profession very, very much in the development of this congress and this was Professor Sugino. Professor Sugino was in Chapel Hill for a while so he was an internationally trained person. He really was the man who had this in the insight in the needs of the interaction between international scientists and local scientists to make this congress a success and Zugino was extremely helpful. And second or lastly Kurokawa, who then became president of the ISN at that time, had returned form the United States to Japan and he, also with the help of Sugino, got involved in the scientific structure and organization of the programs. Kurokawa was the most stimulating and effective member of the scientific committee and congress.

JS:

Since we are on the issue of the ISN congress, one sometimes wonders what the role of such a gigantic congress as that is. How do you see this?

KT:

The congresses of the International Society of Nephrology have changed their aims compared to the very beginning. In 1959, it was a forum for nephrologists, for clinicians, for basic researchers to interact with each other., but primarily from countries where research was in full flower: United States, West Europe, Scandinavia, Italy, but over the years the character of this congress, I think, has changed correctly. Because no doubt the ASN, is a yearly congress in the United State, so international that any international similar congress run by the ISN would have been a duplicate and not very effective. So ISN realized that their primary role is to bring nephrology to areas where nephrology, basic or clinical, is less developed in countries we mentioned before. So the present idea is to have congresses in cooperation with local regional organizations in the renal field and bring the experts and the people to those places to stimulate, not only the local nephrologists and to give them an international reputation, but to tell the government and the supporting agencies how important for the people and for society that renal research and nephrology become important issue in their decisions and so far ISN feels an important function in those areas of the world where, as I said, nephrology has not developed to that level as in the developed countries.

JS:

Could you give me a specific example?

KT:

I remember very well, for example, that the congress of nephrology in 1990 in Tokyo was, at the time, when nephrology in Japan was certainly not as developed as it is now. I think in other words the congress was an enormous stimulus in Japan and similar in South America not forgo. We had a fantastic, not a congress, but workshops in Africa, which has led to an African Nephrological Society. Here is the place where the international society plays an enormous positive role in their developing and pushing nephrology in those areas.

JS:

Not perhaps just by organizing congresses.

KT:

No, better or not, a congress is the most effective measure of those developments. I agree, I would question that. More important are smaller meetings and more intensive interaction between individual scientists as can be done in international huge congresses.

JS:

And the realization of that perhaps led to the establishment of the International Fellowship Program.

KT:

Correct. The fellowship program is one important component in this respect but also I think the forefronts in Prussia which had been developed by ISN, which brings together scientists, I should say, from the inner circle of nephrology and scientists, from outside nephrology, to interact in different places of the world that again I think it is more effective than any of these huge international congresses.

JS:

Maybe one could say that you have certainly been active and perhaps an activist as president. You tried to get the audience and interest of the International Council of Scientific Unions and you suggested the formation of a number of ISN commissions and a number of other things among the forefront in Prussia. So if you look about at presidency, what do you think were your main achievements and were there any disappointments?

KT:

Well, to begin with a disappointment is perhaps to mention the idea of having ISN as a member of the International Council of Scientific Unions. Now what this international council is, it is an umbrella organization for international scientific unions and organizations and academies. I thought by having ISN incorporated in this international community, the interaction with other relevant scientific unions and exchange with them in programs in supporting our other interdisciplinary programs would be more effective. Maybe that was too much to ask for this international interaction is essential. Perhaps that was too much to ask for in the case of nephrology. This connection has not really lead to any obvious results. Maybe one day or another at a present time. Now the other more effective development was the establishment of scientific commissions. Again, the idea of having a smaller group of scientists, which we would define as belonging to a nephrology and scientists from outside: immunology, genetics, cell biology, etc, etc, to interact in these commissions and have joint meetings, which has finally led to something still existing and very successful. The idea and I think primarily one of the driving force behind this movement was Ike Robinson to establish the forefronts in nephrology. In 1989 these forefronts have been established as a formal official program of ISN. The director of this program for many, many years from the beginning on was Gerhard Gebish and Gerhard did a fantastic job of directing this program so that this became a great success and the forefronts at are still one of the major programs besides other supporting programs for younger scientists etc, etc, in the ISN.

JS:

One last question if I may, there are parent societies in the international area in the field of nephrology like: ISN and the European ERA, EDTA society, how do you see the necessity of co-existence between these societies?

KT:

Well, we have regional societies in different areas of the world, for example ERA, EATA in Europe, the Asian Nephrological Society in the pacific. I think there is a need for those regional groupings because of specific problems related to the geographical area whether these are religious, ethnical, organizational, political issues which differ from area to area, from region to region. So far I think the interaction of scientists and clinicians in their regional groupings is a contributing element to the development of this case nephrology in their specific regions. Besides that, the international societies, International Society of Nephrology ISN, has an umbrella function, in a global dimension and so far it is complementary to ISN but not superfluous.