Floyd C. Rector, Jr., MD
January 15, 2023
Leaders in all branches of human endeavor enhance their
environs and erect new edifices to provide new paths and
portals for those who follow. For nephrology in the second half
of the 20th century, Floyd Rector was such a leader, using his
rare intellectual gifts and creative insights to forge major new
advances in basic and clinical kidney research. Dr. Rector, the 11th president of the American Society of Nephrology (ASN), died on January 15, 2023, just 13 days shy of his 94th birthday.
Floyd Clinton Rector Jr. was born and raised in the small
town of Slaton in West Texas, where he attended nearby Texas
Tech University and earned a B.S. degree with honors in 1950.
He then went on to Dallas and the fledgling University of Texas
Southwestern Medical School, graduating with the M.D. degree,
again with honors, in 1954. It was here that he garnered
the attention and respect of Dr. Donald W. Seldin, Chairman
of the Department of Medicine, who would go on to mentor
his exceptional student through the next two years of medical
residency training, arrange for him to receive intensive research
training in renal acid–base physiology at National
Institutes of Health, and then encourage him to return to
Dallas in 1958 to establish the program that over the next
15 years would prove to be one of the world's most productive
schools for basic and clinical renal research.
In 1973, Floyd accepted an offer from Dr. Holly Smith, Chair of Medicine at the University of California, San Francisco, to serve as Professor and Director of the Division of Nephrology. The next 16 years saw stunning discoveries of mechanisms and regulation of tubule ion transport, urinary acidification, and urinary concentration and dilution, among many other areas discussed in further detail below. Once again, Floyd Rector created a worldclass research environment for exploration of mechanisms of kidney function and regulation in health and disease.
From 1989 until his retirement in 1995, Dr. Rector took on
an administrative role as Chair, Department of Medicine. He
proved to be a warm and popular leader and mentor, not only
to students but to younger faculty forging their own independent careers as investigators and clinical scholars.
Throughout his careers in Dallas and San Francisco, Floyd
greatly enjoyed bedside teaching of medical students, residents, and clinical fellows. As with his mentor, Dr. Seldin, these rounds usually involved a highly cerebral dissertation on
nephron ion transport regulation to explain the underlying
cause of a patient's particular fluid and/or electrolyte disorder,
with the patient and many of the surrounding medical team
agog and bewildered by the onslaught of uncommon erudition.
Dr. Rector was generally considered to be a demanding
but gentle interrogator of those surrounding him, traits also
recognized by those in the Rector laboratory where daily
research findings were also usually dealt with in a rigorous
yet cordial manner. In recognition of these qualities Dr. Lee
Goldman, Dr. Rector's successor as Department Chair at
University of California, San Francisco, established an annual
Floyd C. Rector, Jr. Residency Research Symposium designed
to highlight the scholarly work of students and residents in areas of basic and clinical investigation as well as innovations
in delivery of medical care. For many years into his retirement,
Floyd was a regular and devoted attendee and speaker at these
Much of Dr. Rector's research effort in Dallas focused on
mechanisms of renal ion transport contributing to Extracellular
fluid volume and acid–base balance and imbalance. James
Clapp and Floyd Rector demonstrated active chloride transport
in the distal nephron. Rector, Seldin, and Norman Carter further
showed that bicarbonate reabsorption and proton secretion in
proximal and distal tubules could best be explained by hydrogen ion secretion across the apical membrane, rather than direct bicarbonate reabsorption, as evidenced by acid disequilibrium pH during carbonic anhydrase inhibition. Under Dr. Rector's direction, numerous clearance and micropuncture studies involving Jaime Herrera, Manny Martinez-Maldonado, Felix Brunner, Wadi Suki, Neil Kurtzman, Roland Blantz, among
others, explored mechanisms of tubule fluid reabsorption in
the regulation of body fluid balance. In collaboration with Juha
Kokko, Dr. Rector identified the ion transport properties of
isolated and perfused segments of rabbit thin limbs of Henle,
which inspired creation of a unique biological model of the
countercurrent multiplication system devoid of active solute
transport to explain how urine is concentrated. John Fordtran,
soon to be recognized as a renowned gastroenterologist, collaborated closely with Dr. Rector to perform classical studies of solute and water absorption across discrete segments of small intestine in normal human subjects as well as those with various forms of malabsorption.
In San Francisco, Dr. Rector's new team, including Robert
Alpern, Martin Cogan, David Warnock, and Christine Berry,
showed that the removal of bicarbonate from luminal fluid
produced concentration gradients that secondarily drove the
passive reabsorption of chloride. Dr. Rector also led the effort
to define the sodium and hydrogen transport systems in the
proximal tubule, identifying a sodium–hydrogen exchanger
and a proton ATP-ase. In addition, the team discovered a
coupled carrier whereby two bicarbonate ions and one sodium
ion move simultaneously across the basolateral membrane,
driven by the lumen negative electrical potential, without the
need for additional active transport.
Dr. Rector collaborated with clinical researchers Drs. Anthony Sebastian and Morris Schambelan in translating concepts derived from bench research to designing and executing meticulous metabolic balance studies to account for the findings in a patient with hyperkalemia, hyperchloremic metabolic acidosis, and resistance to aldosterone. Following sodium sulfate (a nonreabsorbable anion source) rather than sodium chloride infusion into the patient revealed an underlying defect of increased chloride permeability in the distal nephron. The finding inspired proposal of the concept of a "chloride shunt" whereby dissipation of the distal tubule electrical potential difference interferes with potassium secretion and augments sodium reabsorption, giving rise to the phenotype of type II pseudohypoaldosteronism with hyperkalemia and hypertension. Richard Lifton and coworkers at Yale subsequently demonstrated that with no lysine [K] kinase mutations in the distal tubule resulted in gain-of-function of this chloride shunt, establishing a molecular genetic basis for the electrolyte disturbances observed in this disorder. Such give and take between bench and bedside encouraged Dr. Rector's basic science and clinical teams to approach other more common clinical disorders, including metabolic acidosis and alkalosis, hyperkalemia and hypokalemia, and disorders of calcium homeostasis, among many others.
Floyd Rector led two outstanding laboratories that delved
deeply into challenging questions in renal biology and medicine. His clinical associates shared his passion for applying
basic science concepts to problems of fluid and electrolyte
homeostasis. Both spheres attracted dozens of bright young
minds for fellowship training under his tutelage, their names
too numerous to recount here. Suffice it to say that many have
gone on to highly successful careers in academia, biotechnology, and clinical practice. With them more than 150 original, peer-reviewed papers saw publication in the most respected scientific journals.
Floyd was a visiting professor at many institutions. He
served on many editorial boards and was elected to the most
respected academic societies. Among his many prestigious
awards were the Homer Smith Award of ASN in 1982, Distinguished Texas Tech Alumnus Award in 1987, Mayo Soley
Award of the Western Society for Clinical Research in 1990,
Donald W. Seldin Award of the National Kidney Foundation in
1996, establishment at University of Texas Southwestern of two
Floyd C. Rector Jr. Endowed Chairs (in Nephrology in 2001
and Medicine in 2003), the A.N. Richards Award of the International Society of Nephrology in 2001, and the Robert W.
Berliner Award of the American Physiological Society in 2002.
He served as president of the ASN from 1976 to 1977 and
councilor of the International Society of Nephrology from
1978 to 1985.
One afternoon in the spring of 1973, soon after Floyd
arrived in San Francisco, we met at my home in Mill Valley at
the invitation of the W.B. Saunders medical book publishers to
design and organize a new and comprehensive textbook of the
kidney, including basic anatomy, physiology, biochemistry and
molecular biology, pathophysiology, pathology, and the diagnosis and treatment of renal disease. With wonderful canapés prepared by my wife Jane, accompanied by a full-bodied and well-aged Napa Valley Cabernet Sauvignon, we spent 4 hours laying out a blueprint of five sections and 44 chapters authored by nearly 100 highly respected experts. Thirty months later saw the release of the First Edition of Brenner and Rector's "The Kidney." Floyd joined in editing the next three editions, while the textbook secured a strong worldwide reputation among students, residents, fellows, established renal scientists, and practitioners of nephrology, urology, internal medicine, and pediatrics. For Floyd's invaluable vision, guidance, and encouragement over those four editions, the next (fifth) edition was dedicated to him in honor of his splendid service. Now 50 years since the original Brenner and Rector was designed, our shared legacy continues with the 12th edition currently in production, ably led by six of my former associates.
Floyd Rector leaves in the memories of his family, friends,
and associates a bounty of recollections of a warm, courteous,
and generous man. He was among the greatest in his profession in the 20th century, but despite this well-earned
distinction, he neither sought nor expected an audience. Instead he devoted himself to his wife Marge of 69 years; their
daughters Lynn, Ruth, and Janet; four loving grandchildren;
and six adored great grandchildren. Marge and Floyd shared a
beautiful home in Sausalito, CA, overlooking Angel Island in
San Francisco Bay, where they enjoyed their sailboat, and they
were active golfers and tennis players. Floyd also enjoyed
giving classical guitar performances for family, friends, and
guests. Marge was an accomplished and successful artist working in her architect-designed studio in nearby Woodacre until her death in 2019.
From these few fine threads that have been teased from the glorious tapestry that was Floyd Rector's life, we can readily
discern his special virtues of high intelligence, creativity, undistracted focus, and his warmth and generosity. Long after his tapestry turns to dust, his contributions to science and medicine will not only endure but also continue to provide opportunity and direction for generations of successors. And for those of us fortunate to have known him personally, our tapestries will have become more storied, vibrant, and enlarged.
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