Who and what drove Walter Kempner? The rice diet revisited.

Abstract

The refugee with the strong German accent explained his ideas about renal failure to his skeptical medical students. “The problem with renal failure is the resultant metabolic dysfunction. The kidneys excrete waste products, amino acids, keto-acid metabolites, hydrogen ions, the salt that is eaten, and all these things are the result of what the people are eating. Theoretically, we should be able to make them better by reducing the amount of work the kidneys have to do. Namely, we could radically alter the patients’ diets and thereby save lives.” The (Duke University) students challenged the Herr Professor. “Sounds cool but prove it!” And so he did. The ideas behind this gallant hypothesis were not that novel. Others had prescribed various similar ideas about reducing renal work by modifying the diet, particularly in terms of sodium content.1 However, they had not been that successful in sending the kidneys on vacation.2 Kempner introduced the first comprehensive (global) dietary program to treat chronic renal disease. By doing so, he revolutionized not only that disease but also the treatment of hypertension, obesity, and a host of other disorders.3 Furthermore, perhaps unintentionally he raised the issue of lifestyle, because following his regimen required a change in just that. His own contribution, the Kempner name, the times in Germany and elsewhere, the environment, the technical advances, and the driving force behind a young medical faculty and its visionary leaders should not be forgotten. The ideas that Kempner left us have been archived by remarkable associates and contemporaries, whose memories, such as Newborg4 and Stead,5 guide us in terms of our current interpretations. Without them, we would have missed much of Kempner’s work, and some of us would have had less tachycardia at grand rounds.6 The 49-year-old diabetic hypertensive patient was …