Division History

The History of Pediatric Nephrology, Dialysis, and Transplantation in Atlanta

1970s - 2017

The Genesis: In October 1980, Mrs. Pauline Smith from Baxley, Georgia wrote a letter to her congressman, the Honorable Loyce Turner of Valdosta, as well as to Georgia’s Governor, George Busbee, on behalf of her 3 year old grandchild who had kidney disease and was in need of dialysis and a kidney transplant. While these were then new technologies, available at only a few centers around the country, Mrs. Smith pleaded that these were services “badly needed … in Georgia … not only for … families … but our teaching centers would benefit as well.” At about the same time, we at Emory and Children’s Healthcare of Atlanta (then Egleston Children’s Hospital) were ramping up as expeditiously as possible to provide the very life-saving services that Mrs. Smith’s grandchild required. That it had become possible to provide such life-saving services in our state was the culmination of remarkable research and pioneering clinical efforts that had taken place in the 1950s, 60s and 70s. Unfortunately, however, our state’s first pediatric nephrologist, Robert MacDonell, had not been able to convince the powers that be to provide the resources for these complex and expensive services. Instead, he had no choice but to refer patients in need to transplant centers as far away as Minnesota for their care.

Division Beginnings and Inauguration of Pediatric Hemodialysis: Although Dr. MacDonell moved to Nashville, Tennessee in 1978, he left a mark on a young Emory pediatric resident, Dr. Barry Warshaw, a native Atlantan who had moved to Los Angeles in 1976 to begin a fellowship in pediatric nephrology, dialysis, and transplantation at the Children’s Hospital of Los Angeles under the mentorship of early pediatric nephrology pioneers including Richard Fine, Robert Ettenger, and Ellin Lieberman. Dr. Warshaw returned to Emory in 1979 and inaugurated the Division of Pediatric Nephrology where he was joined the following year by Dr. Leonard Hymes, another former Emory pediatric resident who had completed a year of pediatric nephrology fellowship in San Francisco with Drs. Malcolm Holliday and Don Potter. As a division of two physicians for the ensuing 26 years, Drs. Warshaw and Hymes introduced chronic pediatric dialysis services to Georgia’s children for the first time, starting in 1980 working in concert with the Emory-affiliated adult dialysis program at Grady Hospital, and then in 1984 opening the state’s only dedicated pediatric dialysis unit at Egleston Hospital. Located in the basement floor of the hospital, the colorful unit without windows answered the prayers of Georgians such as Mrs. Smith and many others, and was expertly staffed by adult-turned-pediatric dialysis nurses Bertha Dee Clowers (our inaugural head nurse), Carolyn Mitchell (still with us after all these years), Mary Marks, and many others. Simultaneously during the early 1980s, particularly important developments impacted the field of pediatric dialysis, for it was then that double lumen, subcutaneously-tunneled hemodialysis catheters were developed, displacing the earlier Scribner shunts to the great benefit of patients and nephrologists alike, and obviating the need for inefficient blood pumps that previously had pumped blood to and fro through single lumen central catheters.

Birth of Chronic Peritoneal Dialysis: In its earliest iterations, peritoneal dialysis had necessitated the insertion of stiff trocars and the use of bottled fluids and was practical only for acute treatments for no more than a few days. By 1980, silicone-based, soft, subcutaneously tunneled, cuffed peritoneal dialysis catheters (thus providing a barrier to infection and peritonitis) as developed by Dr. Henry Tenckhoff in Seattle, and parenteral fluids newly packaged in soft plastic bags in lieu of glass bottles (obviating the need for venting to the outside and thus facilitating a safer, more closed system), had become available, making chronic peritoneal dialysis possible for the first time, to the great benefit of our patients who could be taught to perform this life-saving procedure at home. Now, even infants as well as those who did not live close to our hospital could be offered dialysis.

Pediatric Transplantation: Once chronic dialysis treatments had become available to stabilize patients, a team of nephrologists and pediatric and adult urologic surgeons, including Drs. John Woodard, David O’Brien, and Ken Walton, launched our pediatric renal transplant program, commencing with the first 4 procedures performed at Emory Hospital in 1980, followed by the inauguration of the Egleston Hospital transplant program the following year. Unfortunately, our very first pediatric transplant, in an 11 year old girl with kidney failure resulting from treatment-resistant nephrotic syndrome, failed due to the presence of premature atherosclerotic plaques in the patient’s blood vessels. However, many successes followed in a field that would undergo substantial improvements in the ensuing decades. In 1984, Emory recruited Dr. John Whelchel from Birmingham, Alabama to become its first full-time transplant surgeon, and our pediatric transplant numbers started to grow. Margaret Shaw was recruited from Grady Hospital to become our first full-time nurse practitioner and transplant coordinator (fulfilling roles that would eventually require nearly a dozen individuals), succeeded in 2000 by Nancy O’Brien who would build upon her pediatric and urologic nursing experiences to dedicate herself to our transplant patients for the ensuing 11 years. In 2005 Lynn Sherrer brought a wealth of dialysis and pediatric experiences as a nurse practitioner and applied those experiences effectively over the years in the service of our general nephrology, dialysis, and transplant populations. What started off as a small transplant program increased steadily in size, paralleling a rapidly growing population in Atlanta and Georgia, culminating in the performance of as many as 35 transplants in 2006, among the largest number in the nation. Transplant surgical leadership passed on to Emory surgeons Christian Larsen and Tom Pearson, disciples of Dr. Whelchel and other mentors, who became world-class investigators themselves into a new class of transplant immunosuppressive medications (co-stimulation blockers) with the potential to significantly advance the field of organ transplantation. They were complemented by the team of Robert Bray and Howard Gebel, PhD leaders of the Emory Histocompatibility (HLA) lab whose leadership at the national level helped revolutionize donor-recipient matching in organ transplantation. In 2016, after several years serving as surgical directors of renal transplant at CHOA while also expanding their surgical group, Drs. Larsen and Pearson passed the mantle of CHOA director of renal transplant surgery on to Dr. Nicole Turgeon, who had come to Emory following her surgical training at the University of Massachusetts and her transplant surgery fellowship at the University of Wisconsin. At the same time that our CHOA transplant program was growing and benefitting from an increasingly world-class Emory research environment, our dialysis patient population was growing to numbers unforeseen when the program was initially established. With the opening in 2002 of the Center for Transplantation on the 6th floor of CHOA/Egleston Hospital, our program was treating upwards of 30 children with hemodialysis or peritoneal dialysis and finally doing so in a relocated pediatric dialysis unit with windows to the outside world! This unit served us well until 2013, by which time we had outgrown its capacity as well, whereupon we contracted with Davita Dialysis to move our maintenance dialysis program to a free standing, pediatric-only Davita unit in nearby Tucker.

Camp Independence: From its earliest years, our program sought to normalize the lives of children and teens with chronic kidney disease. Camp Independence became the social centerpiece of this effort, commencing as early as the late 1970s, antedating even the birth of our Division, and continuing to this day. Initially conceived and sponsored by the National Kidney Foundation of Georgia and more recently sponsored by Children’s Healthcare of Atlanta, Camp Independence was initially spearheaded through the efforts of an Emory adult nephrologist, Ronald Mars, and later led for more than two decades by Dr. Hymes (famously wielding his super-soaker). Moving from one venue to another in its early years, Camp Independence eventually settled at Camp Twin Lakes in Rutledge, Georgia, developed as an ideal facility for a long list of health-related camps. While the success of Camp Independence owes to the enthusiasm and dedication of countless nurses and other volunteers over the years, general nephrology and dialysis nurse Lisa Warren stands out as the longest serving of these, commencing her service in 1988 and currently planning for her 29th camp in 2017. A one week experience for campers with kidney disorders, transplants, or dialysis-dependency, Camp Independence has proven transformative for the lives of campers and a lesson in resilience for all who witness.

New Division Leadership and Faculty Growth: With the remarkable growth of our transplant and dialysis patient populations, not to mention our overall nephrology practice, the numbers had become too large to be managed by only two nephrologists. Accordingly, the Division initiated an entirely new trajectory in 2006 with the recruitment of Larry Greenbaum, MD, PhD, from the Children’s Hospital of Wisconsin in Milwaukee, as our new Division Director. Dr. Greenbaum had completed his nephrology training in 1995 at UCLA and had spent the first 10 years of his career in Milwaukee. With the support of Emory’s Department Chair, Dr. Barbara Stoll, Dr. Greenbaum brought outstanding academic skills to the task and was afforded sufficient resources to begin to grow the division clinically and academically, increasing the size of the division over the ensuing 10 years from 3 nephrologists to 10 and developing a substantial clinical research infrastructure and portfolio. That research growth was facilitated by Margo Kamel MSPH, PhD, whom Dr. Greenbaum recruited to our program from Memphis in 2008 to become our lead research coordinator and who has proceeded to build and lead a productive research support staff. The national reputation of the Division began to grow likewise, culminating in top 10 rankings in the US News and World report rankings in 2015 and 2016. In 2016, Dr. Greenbaum himself did the program and our institutions proud in rising to the presidency of the American Society of Pediatric Nephrology, our national organization.

The first physician to be recruited to the division by Dr. Greenbaum was Dr. Sandra Amaral, who joined us later in 2006 after her fellowship training at Johns Hopkins and who lead the development of our important kidney transplant adolescent transition clinic. The birth of her 2 children within the ensuing 4 years also marked the first offspring for our division faculty in several decades! With her growing family, Dr. Amaral moved to the Children’s Hospital of Philadelphia in 2011 where she could be nearer to the support afforded by her own extended family who lived nearby.

Fellowship Program: In 2007, Dr. Greenbaum as Division Director and Dr. Warshaw as Program Director, with the skillful assistance of MaryJane Polizzotto as Program Coordinator, launched the Division’s first fellowship training program. Beginning with a single inaugural follow, Jennifer Jackson, M.D., in 2007, the 3 year training program has recruited 1 to 2 fellows annually and will comprise a total of 5 fellows by July 2017, ranking us among the larger pediatric nephrology training programs in the nation. As of July 2017, the program will have graduated 9 pediatric nephrology fellows, and counting, who are currently practicing at various programs throughout the US, marking a growing Emory/CHOA diaspora.

In 2009, the Division recruited Dr. Donald Batisky, a hypertension expert who had completed his pediatric nephrology fellowship training at LeBonheur Children’s Hospital in Memphis in 1993 and had spent the prior 10 years of his career on the faculty at Nationwide Children’s Hospital in Columbus, Ohio. Dr. Batisky became our 5th faculty member.

Unified Nephrology Care across Children’s Healthcare of Atlanta: The year 2012 marked another important turning point for the growth of our program when we were joined by Dr. Stephanie Jernigan, who had completed her nephology training at the University of Washington in Seattle in 1999, whereupon she had joined Dr. Julius Sherwinter in the private practice of pediatric nephrology at our sister hospital, Children’s Healthcare of Atlanta at Scottish Rite. When Dr. Sherwinter retired from nephrology in 2012, the private nephrology practice was closed, our Emory group for the first time assumed full responsibility for inpatient nephrology coverage at Children’s Healthcare of Atlanta at Scottish Rite, as well as at Egleston, and Dr. Jernigan joined our Emory group full-time, marking the point at which our group became the sole pediatric nephrology provider for the entirety of metropolitan Atlanta and most of the state of Georgia, a population catchment of some 10.5 million people, comprising one of the largest catchments for a nephrology division in the nation. Dr. Jernigan brought to our program not only her rich clinical experience and expertise, but also leadership skills that would lead her to serve as President of our CHOA Professional Staff, Medical Director of Camp Independence, succeeding Dr. Hymes, and as an elected representative of our profession nationally to the section on Nephrology of the American Academy of Pediatrics.

With a goal to have a mix of faculty with varied expertise in both clinical and research arenas, in 2012 we recruited Dr. Pamela Winterberg following her fellowship in pediatric nephrology at UT Southwestern Medical Center in Dallas. Dr. Winterberg brought a specific interest in developing a research-focused career and was afforded the requisite protected time and support necessary to develop her research skills and portfolio, now focusing on improving our understanding of cardiovascular complications of chronic kidney disease.

Faculty Growth and Transitions: After 33 years on faculty, Dr. Hymes retired from Emory in 2013, Dr. Jernigan succeeded him as Medical Director of our Dialysis program, and Dr. Roshan George joined the division that year, becoming the first graduate of our fellowship training program to matriculate to our faculty. Dr. Rouba Garro was recruited that same year, having completed her fellowship training at Lucille Packard Children’s Hospital at Stanford University and then having spent three years on the medical staff at the University of Arizona Children’s Hospital in Tucson; passionate about kidney transplantation, in 2017 Dr. Garro would go on to succeed Dr. Warshaw as the Medical Director of renal transplantation at CHOA. In 2015, Dr. Chia-shi Wang became the second Emory pediatric nephrology fellow to join our faculty, our first to undertake a Masters of Science in Clinical Research degree program during her fellowship training, and our 8th faculty member; she joined Dr. Winterberg with protected time to build a research-focused career, with concentration on aspects of nephrotic syndrome in childhood. In that same year, in order to increase our clinical service capacity to meet our seemingly ever-growing demand, we recruited Dr. Stella Shin following completion of her nephrology fellowship at the Children’s Hospital of Cincinnati; Dr. Shin became our 9th faculty member and second Georgia (Conyers) native (in addition to Dr. Warshaw). Finally, Dr. Sabina Kennedy joined us in 2016 in a clinical role following completion of her fellowship training at the Mattel Children’s Hospital at UCLA, where she had extensive exposure to a large transplant population, becoming our 10th faculty member and our 2nd former UCLA trainee (along with Dr. Greenbaum). Our growth journey has transformed us in a relatively short period of time into one of our country’s largest and most diverse pediatric nephrology faculties.

The Present (2017): Along with our 10 faculty and 4 fellows, our division now comprises two nurse practitioners, Lindsay Armstrong, an invaluable contributor to the care of both our general nephrology and hemodialysis patients, and Rachael Mullis, who leads our transplant nursing group. Lynn Sherrer continues her contributions in an administrative oversight role with our Transplant program. We have 4 division nurses (led by Toni-Marie Partridge) involved with our general nephrology patients; 2 with our chronic kidney disease population that now numbers over 100 patients; and 3 serving our post-transplant population that currently numbers 211. Key drivers of our patient-centered care, many of our nurses have long records of service in our program: Lynne Miles (5 years), Rhodina Bly, (9), Lisa Palm, Debbie Stearns, and Vernon Griffith (>10), and Carolyn Mitchell (>30!). One of our nurses, Camille Echols (7 years), became the adoptive mother of one of our transplant patients! We also enjoy skillful contributions from other members of our multidisciplinary team who are remarkable both for their expertise and their loyalty, including social worker Dave Cooper (15 years); transplant pharmacist and director of the country’s only pediatric transplant pharmacy residency program, Rochelle Liverman (>10 years); case coordinator Batoul Bakhshi (7 years); and nutritionist Christine Benedetti. While as of this writing we are not actively recruiting for further additions to our faculty, we remain the sole pediatric nephrology provider to a city and state population of >10 million people that is growing at a rate of some 1 million per decade and a hospital system that has just put in place a plan to build a brand new facility approaching twice the capacity of the current one. From humble beginnings, the future seems large and bright.

Emory / CHOA Pediatric Nephrology Fellows

Name Dates Post-Fellowship Appointment
Jennifer Jackson, MD 2007-2010

University of Kentucky, Lexington, Kentucy

Sandeep Riar, MD 2009-2012

University of Kansas, Kansas City, Kansas

Raed Bou Matar, MD 2009-2012

The Cleveland Clinic, Cleveland, Ohio

Roshan George, MD 2010-2013

Emory University, Atlanta, Georgia

Shahid Nadeem, MD 2011-2014 LSU Health Sciences Center, Shreveport, La.
Frank Ayestaran, MD 2012-2015

All Children’s Hospital, USF, St. Petersburg, Fl.

Chia-shi Wang, MD 2012-2015

Emory University, Atlanta, Georgia

Rima Zahr, DO 2013-2016

LeBonheur Children’s Hospital, Memphis, Tenn.

Alana Bozeman, MD 2014-2017

Gwinnett Pediatrics, Atlanta, Georgia

Loretta Reyes, MD 2015-
K’joy Simms, MD 2016-
Karezhe (Karie) Mersha, MD 2016-
Jackson (Jack) Londeree, DO 2017-
Catherine (Cat) Park, MD 2017-