Director:
Justin Silver, M.D., Ph.D., Professor of Medicine

Faculty:
Justin Silver, M.D., Ph.D., Professor of Medicine
Mordecai M. Popovtzer, M.D., F.A.C.P., Professor of Medicine
Dvora Rubinger, M.D., Associate Professor of Medicine
 

Fellow:
Aharon Bloch, M.D
Olga Gotsman, M.D.
Ronen Levy, M.D
 
Research Assistants:
Pnina Scherzer, Ph.D.

Units:
Bone and Mineral Metabolism, Director: Justin Silver; Bone Histomorphometry Laboratory (a section in Renal Laboratory), Physician-in-charge: Anca Gal-Moscovici

Centers:
Minerva Center for Calcium and Bone Metabolism, Director: Justin Silver; Hemodialysis Centers (Ein Karem and Ziv), Director: Dvora Rubinger; The Hadassah Jerusalem Osteoporosis Center, Director: Joseph Foldes, M.D.

Clinical and Research Activity

Clinical Activity:
• Nephrology and Hypertension Services provide medical care for patients affected by kidney diseases; water, electrolyte and acid base abnormalities, bone and mineral disorders and arterial hypertension. The clinical service is extremely active and large and includes organ transplant patient care.

• Nephrology and Hypertension Services focus their attention on the diagnosis of parenchymal renal diseases and on delivery of comprehensive care for patients with primary and secondary kidney diseases. A special priority is performing and interpreting diagnostic kidney biopsies both of native kidneys and renal allografts.

• Nephrology and Hypertension Services serve as a referral center for metabolic bone diseases and disorders of mineral metabolism. We have introduced in this country diagnostic bone biopsies on an outpatient basis.

• The Bone Histomorphometry Laboratory operates a highly advanced computerized system, a unique one in this country. This is one of the few laboratories in the world with international reputation and recognition for its professional excellence.

• OSTEOPOROSIS, Director: Yosef Foldes
The Jerusalem Osteoporosis Center operates two highly advanced DEXA densitometers, an experimental ultrasonic device and runs 3-times a week an outpatient consultation clinic. Patients with complex skeletal diseases are admitted to the hospital for further work-up. The clinic provides care for patients referred locally and from outside Jerusalem, including from overseas.

• The Renal Laboratory provides a resourceful diagnostic support by performing specific tests including vitamin D and its metabolites' assays, measurements of aluminum levels, three bone markers and cyclic AMP levels.

• Dialysis: Dialysis is our principal clinical preoccupation. We run two hemodialysis units and one chronic ambulatory peritoneal dialysis (CAPD) unit. Our dialysis centers provide comprehensive daily medical care for over 200 patients with end-stage renal disease. Our new predialysis clinic provides 24 hour care for over 80 patients. These patients transfer from the general Nephrology Outpatient Clinic in anticipation of dialysis and/or transplantation. This clinic was awarded with Hadassah Director General's medal for excellence.

• Nephrology and Hypertension Outpatient Services - General Nephrology Clinic, Director: Michael Friedlaender. This clinic meets every Thursday. All physicians participate in the treatment of patients with a wide spectrum of nephrology and hypertension-related disorders including organ transplant recipients. We have around 4000 patient visits annually.

• Renal Transplant Clinic: Director: Michael Friedlaender. This clinic meets every Sunday and Thursday. It is specifically designed for kidney transplant patients. We follow over 250 transplant patients including those who received kidney allografts outside Hadassah. The latter constitute over 30 percent of all our patients.

• Metabolic Bone Disease Clinic: Dr. Anca Gal-Moscovici sees patients on Wednesday afternoons twice a month at Ein-Kerem, investigating and treating patients with all types of metabolic bone disease.

• Ambulatory blood pressure monitoring service: Dr R. Backenroth provides 24-hour blood pressure monitoring at Ein Karem campus. The circadian blood pressure profile is important for  assessment of blood pressure control and prediction of end organ damage.
 

Research Activity:
Renal physiology and pathophysiology.

The following are some of the selected topics:

A. K+ metabolism. The physiology of K+ channels; ROMK and CHIF, their gene expression and protein abundance in health and in disease.

B. Resetting of glomerulotubular balance in diabetic kidney. Na-K-ATPase activity in diabetic kidney in animals with type I and type II diabetes animal models and in the aging kidney. These experiments provide an insight into the process that initiates the tubulointerstitial injury in diabetic nephropathy and aging kidney.

C. Water preservation in arid areas. Survival in arid areas requires water conservation. We have launched experiments in desert rodents (Psammomys) to explore urinary concentrating mechanism(s), by correlating Na transport activity with the gene expression of Na-K-ATPase. Our data show that urea-dependent passive Na transport plays a major role in the urinary concentrating system, rather than active, Na-pump dependent transport. Further studies related to urea transporters are underway.

D. Renal tubular phosphate transport. Studies of phoshate transport and of the interaction of PTH with vitamin D in normal and distase states.

E. Signal transduction pathways in bone: Calcium efflux and influx in bone organ culture. The signal transduction pathways of calcemic hormones such as PTH, 1,25(OH)2 vitamin D3 and 24,25(OH)2 vitamin D3 in bone organ cultures.

F. Experimental renal bone disease.

G. Immunomodulatory fusion proteins. Studies on induction of tolerance to specific antigens, with special interest in alloantigens. Clinical Research. The following are few selected topics only.

H. Autonomic nervous system dysfunction in the uremic state.
These studies address the cardiovascular instability in patients undergoing chronic hemodialysis.

I. Uremic osteodystrophy. Therapeutic trials for bone disease in dialysis patients. Further studies to define the changing spectrum of uremic osteodystrophy, with an emphasis on the adynamic bone disease, are in progress.

J. Diagnostic new techniques for assessment of bone status. These and other related studies are conducted in the Hadassah Osteoporosis Center. Likewise, many therapeutic trials in association with pharmaceutical industry are underway.

Teaching Activities

Preclinical:

• Biochemistry and physiology of mineral metabolism and integrative renal physiology Clinical:
• Introductory course to clinical medicine
• Seminars to students in their internal medicine clerkship year
• Electives in their final years
  

Nurses:

• Intensive care course for nurses.
  

Centers:
Hadassah Hemodialysis Centers
Hadassah Jerusalem Osteoporosis Center
Minerva Center for Calcium and Bone Metabolism (see appendix).

Future projects:

We plan to create a center for hereditary renal diseases with an emphasis on the kidney disease in the Kurdish community. Members of the Kurdish community similarly to the Kochin community, show very high incidence of renal diseases progressing to end-stage renal failure. This center will be a sub-unit of the Hadassah Center for Gene Therapy.

Nephrology and Hypertension Services
Hadassah University Hospital, PO Box 12000
Jerusalem, Israel 91120
Tel: +972 2 6776881; Fax: +972 2 6446335
Email: silver@cc.huji.ac.il