Nephrologists
37 years of experience
Video profile
Accepting new patients
University City
Hospital of the University of PA
3400 Spruce St
Philadelphia, PA 19175
215-662-2642
Locations and availability (6)

Education ?

Medical School Score Rankings
Yeshiva University (1973)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Appointments
University of Pennsylvania
Associate Professor of Medicine Director, Kidney Stone Evaluation Center
Associations
American Board of Internal Medicine

Affiliations ?

Dr. Wasserstein is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • Pennsylvania Hospital University PA Health System
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • Hospital of the University of PA *
    3400 Spruce St, Philadelphia, PA 19104
    • Currently 4 of 4 crosses
    Top 25%
  • University of PA Medical Center/Presbyterian
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Graduate Hospital
    1800 Lombard St, Philadelphia, PA 19146
    • Currently 1 of 4 crosses
  • Clinical Practices of the University of Pennsylvania
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Wasserstein has contributed to 16 publications.
    Title Institutional Leadership and Faculty Response: Fostering Professionalism at the University of Pennsylvania School of Medicine.
    Date December 2007
    Journal Academic Medicine : Journal of the Association of American Medical Colleges
    Excerpt

    Fostering professionalism requires institutional leadership and faculty buy-in. At the University of Pennsylvania School of Medicine, policies and educational programs were developed to enhance professionalism in three areas: conduct of clinical trials, relations with pharmaceutical manufacturers, and the clinical and teaching environment. Responsible conduct of clinical trials has been addressed with mandatory online education and certification for clinical investigators, but some still fail to recognize conflicts of interest. Activity of pharmaceutical representatives has been strictly regulated, meals and gifts from pharmaceutical companies prohibited, and the role of the pharmaceutical industry in the formulary process and in continuing medical education curtailed. Some faculty members have resented such restrictions, particularly in regard to their opportunity to give paid lectures. Professionalism in the clinical and teaching environment has been addressed with interdisciplinary rounding, experiential learning for medical students and residents in small groups, increased recognition of role models of professionalism, and active management of disruptive physicians. Leadership has been exerted through policy development, open communications, and moral suasion and example. Faculty members have expressed both their support and their reservations. Development of communication strategies continues, including town hall meetings, small groups and critical incident narratives, and individual feedback. The understanding and endorsement of faculty, staff, and trainees are an essential element of the professionalism effort.

    Title Lessons in Medical Humanism: the Case of Montaigne.
    Date June 2007
    Journal Annals of Internal Medicine
    Excerpt

    Michel de Montaigne, the great French humanist and inventor of the personal essay, suffered from frequent and severe renal colic. He wrote about his illness in his travel journal and in his last and greatest essay, "Of Experience." In his illness narratives, Montaigne integrated disease and suffering into his life and art. He humanized rather than conquered his disease. A mature humanism replaced his youthful Stoic philosophy of detachment and disengagement and provides a worthy model for our own medical humanism.

    Title Mentoring at the University of Pennsylvania: Results of a Faculty Survey.
    Date June 2007
    Journal Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine
    Excerpt

    BACKGROUND: Research suggests mentoring is related to career satisfaction and success. Most studies have focused on junior faculty. OBJECTIVE: To explore multiple aspects of mentoring at an academic medical center in relation to faculty rank, track, and gender. DESIGN: Cross-sectional mail survey in mid-2003. PARTICIPANTS: Faculty members, 1,432, at the University of Pennsylvania School of Medicine MEASUREMENTS: Self-administered survey developed from existing instruments and stakeholders. RESULTS: Response rate was 73% (n = 1,046). Most (92%) assistant and half (48%) of associate professors had a mentor. Assistant professors in the tenure track were most likely to have a mentor (98%). At both ranks, the faculty was given more types of advice than types of opportunities. Satisfaction with mentoring was correlated with the number of types of mentoring received (r = .48 and .53, P < .0001), job satisfaction (r = .44 and .31, P < .0001), meeting frequency (r = .53 and .61, P < .0001), and expectation of leaving the University within 5 years (Spearman r = -.19 and -.18, P < .0001), at the assistant and associate rank, respectively. Significant predictors of higher overall job satisfaction were associate rank [Odds ratio (OR) = 2.04, CI = 1.29-3.21], the 10-point mentoring satisfaction rating (OR = 1.27, CI = 1.17-1.35), and number of mentors (OR = 1.60, CI = 1.20-2.07). CONCLUSIONS: Having a mentor, or preferably, multiple mentors is strongly related to satisfaction with mentoring and overall job satisfaction. Surprisingly, few differences were related to gender. Mentoring of clinician-educators, research track faculty, and senior faculty, and the use of multiple mentors require specific attention of academic leadership and further study.

    Title Effectiveness of a Two-part Educational Intervention to Improve Hypertension Control: a Cluster-randomized Trial.
    Date January 2007
    Journal Pharmacotherapy
    Excerpt

    STUDY OBJECTIVE: To measure the effectiveness of a multifaceted educational intervention to improve ambulatory hypertension control. DESIGN: Cluster-randomized trial. SETTING: Academic health system using an ambulatory electronic medical record. SUBJECTS: A total of 10,696 patients with a diagnosis of hypertension cared for by 93 primary care providers. INTERVENTION: Academic detailing, provision of provider-specific data about hypertension control, provision of educational materials to the provider, and provision of educational and motivational materials to patients. MEASUREMENTS AND MAIN RESULTS: The primary outcome was blood pressure control, defined as a blood pressure measurement below 140/90 mm Hg, and was ascertained from electronic medical records over 6 months of follow-up. We determined the adjusted odds ratio for the association between the intervention and the achievement of controlled blood pressure. When we accounted for clustering by provider, this adjusted odds ratio was 1.13 (95% confidence interval 0.87-1.47). Adjusted odds ratios were 1.03 (95% confidence interval 0.78-1.36) in patients whose blood pressure was controlled at baseline and 1.25 (95% confidence interval 0.94-1.65) in those whose blood pressure was not. These odds ratios were not significantly different (p=0.11). CONCLUSIONS: These results were consistent with no effect or, at best, a relatively modest effect of the intervention among patients with hypertension. Had we not included a concurrent control group, the data would have provided an unduly optimistic view of the effectiveness of the program. The effectiveness of future interventions may be improved by focusing on patients whose blood pressure is uncontrolled at baseline.

    Title Pulmonary Hypertension Among End-stage Renal Failure Patients Following Hemodialysis Access Thrombectomy.
    Date June 2005
    Journal Cardiovascular and Interventional Radiology
    Excerpt

    PURPOSE: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy. METHODS: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression. RESULTS: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14). CONCLUSION: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension. Patients with ESRD are more likely to have pulmonary hypertension.

    Title Recombinant Human Erythropoietin Usage in a Large Academic Medical Center.
    Date September 2002
    Journal The American Journal of Managed Care
    Excerpt

    OBJECTIVE: Recombinant human erythropoeitin (rhEPO) is a highly effective but expensive drug used for the treatment of certain anemias. We considered opportunities to curtail inpatient rhEPO utilization in light of therapeutic alternatives, the drug's delayed onset of action, and the available literature. STUDY DESIGN: A retrospective review of rhEPO administration in a large academic medical center between February and June 2000 was conducted by using administrative databases. METHODS: The computerized inpatient pharmacy transaction file of the Hospital of the University of Pennsylvania was queried to determine trends for rhEPO administration. We then employed CaduCIS (CareScience, Philadelphia, PA) to determine the clinical diagnoses and resources used for each inpatient receiving rhEPO. RESULTS: In the study period, 248 inpatients received at least 1 rhEPO dose. More than 100 different physicians, representing 20 departments and divisions, ordered approximately 17 million units of rhEPO. Hematology/Oncology accounted for 33% of all units ordered, and Surgery and General Medicine ordered 16% and 14%, respectively. The usual length of stay for patients receiving rhEPO varied considerably: 34% of patients remained in hospital for < or = 7 days, while 31% remained > or = 3 weeks. As many as 34% of patients began rhEPO therapy as inpatients. Of inpatients receiving rhEPO, only 49% met labeled indications for rhEPO administration. CONCLUSIONS: At our institution, approximately one half of all inpatient rhEPO usage is for an off-label indication. Utilization patterns may suggest strategies for conserving this scarce resource.

    Title The More Things Change...
    Date August 2001
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Title Membranous Glomerulonephritis.
    Date October 1999
    Journal Journal of the American Society of Nephrology : Jasn
    Title Nephrolithiasis: Acute Management and Prevention.
    Date July 1998
    Journal Disease-a-month : Dm
    Excerpt

    The primary care physician has a responsibility not only to recognize and treat acute stone passage but to ensure that the patient with recurrent stones has metabolic evaluation and appropriate preventive care. Renal colic is typically severe, radiates to the groin, is associated with hematuria, and may cause ileus. About 90% of stones that cause renal colic pass spontaneously. The patient with acute renal colic should be treated with fluids and analgesics and should strain the urine to recover stone for analysis. Highgrade obstruction or failure of oral analgesics to relieve pain may require hospitalization; a urinary tract infection in the setting of an obstruction is a urologic emergency requiring immediate drainage, usually with a ureteral stent. Several approaches are available when stones do not pass spontaneously, including extracorporeal shock wave lithotripsy, percutaneous lithotripsy, and ureteroscopic laser lithotripsy. Calcium stone disease has a lifetime prevalence of 10% in men and causes significant morbidity. Renal failure is unusual. Stone types include calcium oxalate, uric acid, struvite, and cystine. Stone analysis is particularly important when a noncalcareous constituent is identified. The majority of patients with nephrolithiasis will have recurrence, so prevention is a high priority. High fluid intake is a mainstay of prevention. Metabolic evaluation will indicate other appropriate preventive measures, which may include dietary salt and protein restriction, and use of thiazide diuretics, neutral phosphate, potassium citrate, allopurinol, and magnesium salts. Dietary calcium restriction may worsen oxaluria and negative calcium balance (osteoporosis).

    Title Death and the Internal Milieu: Claude Bernard and the Origins of Experimental Medicine.
    Date July 1996
    Journal Perspectives in Biology and Medicine
    Title Changing Patterns of Medical Practice: Protein Restriction for Chronic Renal Failure.
    Date June 1993
    Journal Annals of Internal Medicine
    Excerpt

    The use of dietary protein restriction for renal failure has fluctuated during the past 125 years. These fluctuations reflect not only the state of medical knowledge but also social, economic, and cultural factors. Factors inhibiting use of dietary treatment have been its status as an aspect of hygiene rather than as active therapy; the opinions of dominant practitioners and scientists around midcentury, including a presumption that renal adaptation to a high-protein diet must be appropriate; fear of malnutrition and a cultural belief in the virtue of dietary protein; unwillingness by physicians and patients to restrict consumption or lifestyle; and professional identification with the technologies of dialysis and renal transplantation. Factors promoting dietary treatment have been rediscovery of previous work on protein-induced renal injury; a sense that homeostatic compensations could have adverse consequences; federal incentives to curb consumption of scarce resources such as renal dialysis; and the integration of research on, and therapeutic use of diet into scientific medicine. A large ongoing study of dietary protein restriction to limit renal injury will add to our knowledge of this treatment; its application will surely be informed by social and cultural considerations.

    Title Toward a Romantic Science: the Work of Oliver Sacks.
    Date September 1988
    Journal Annals of Internal Medicine
    Title Case-control Study of Risk Factors for Idiopathic Calcium Nephrolithiasis.
    Date January 1988
    Journal Mineral and Electrolyte Metabolism
    Excerpt

    We compared epidemiological risk factors and urine excretion of calcium, phosphate, uric acid, urea nitrogen, sodium, potassium, and fluid volume in recurrent idiopathic calcium stone-formers and in a control group of age- and sex-matched normal volunteers. Stone-formers were less likely than normal subjects to have followed a low-calorie diet, but body weight did not differ between the two groups. Daily urine calcium excretion was a graded risk factor for stone formation throughout its range. Daily urine urea nitrogen and potassium excretion were lower in stone-formers than in controls, but excretion of uric acid, sodium, phosphate, and creatinine did not differ. However, there were positive associations between urine calcium excretion and the urine excretion of sodium, urea nitrogen, uric acid, phosphate, and creatinine in stone-formers; and these associations were significantly stronger than in normal subjects. We conclude that urine calcium excretion is a major risk factor for idiopathic calcium stone formation, but cannot confirm such a role for urine uric acid excretion. Total dietary protein intake may be lower in stone-formers than in controls. However, stone-formers may be more sensitive than normal subjects to the calciuric effects of protein and sodium. A strong association of urine calcium excretion with urine phosphate excretion in stone-formers is probably independent of dietary protein intake.

    Title Controlled Study of Renal Osteodystrophy in Patients Undergoing Dialysis. Improved Response to Continuous Ambulatory Peritoneal Dialysis Compared with Hemodialysis.
    Date July 1987
    Journal The American Journal of Medicine
    Excerpt

    To assess the effect of different dialysis modalities on renal osteodystrophy, a controlled study was performed in six patients undergoing continuous ambulatory peritoneal dialysis and six hemodialysis-treated patients. All patients were enrolled at the initiation of dialysis, and age, sex, cause of renal failure, prior treatment of renal osteodystrophy, and baseline serum and bone histologic variables were similar in the two groups. After initial blood samples and bone biopsy specimens (with double-tetracycline labels) were obtained, renal osteodystrophy in both groups received comparable treatment with aluminum hydroxide to maintain serum phosphorus levels between 3.5 and 5.5 mg/dl, and with calcium carbonate and calcitriol to maintain total serum calcium levels between 10 and 11 mg/dl. Blood and bone samples were obtained again after nine months. All patients were asymptomatic at the beginning and end of the study. Phosphorus values were well controlled, and total calcium increased similarly in both groups. Although ionized calcium levels increased in both groups, the final level was higher in hemodialysis-treated patients than in patients undergoing continuous ambulatory peritoneal dialysis (2.82 +/- 0.07 meq/liter and 2.5 +/- 0.05 meq/liter, respectively; p = 0.005). Amino-terminal parathyroid hormone levels normalized in both groups, and histologic improvement of osteitis fibrosa occurred in a similar proportion of patients in both groups; however, quantitative improvement was greater in the hemodialysis-treated patients. Osteomalacia, assessed qualitatively and by dynamic histomorphometric measurements, was ameliorated to a much greater degree in patients undergoing continuous ambulatory peritoneal dialysis compared with hemodialysis-treated patients. Bone aluminum staining was absent in all biopsy specimens. Overall, bone histologic findings improved to a greater degree in patients undergoing continuous ambulatory peritoneal dialysis. When patients undergoing continuous ambulatory peritoneal dialysis or hemodialysis and receiving similar treatment for renal osteodystrophy were compared, patients treated with continuous ambulatory peritoneal dialysis appeared to have a greater improvement in their metabolic bone disease.

    Title Sleep Apnea in Hemodialysis Patients: the Lack of Testosterone Effect on Its Pathogenesis.
    Date August 1985
    Journal Nephron
    Excerpt

    After the discovery of sleep apnea in 2 patients receiving chronic maintenance hemodialysis, we decided to survey all 29 male patients undergoing outpatient dialysis for symptoms suggestive of sleep apnea. 12 of 29 (41%) had positive clinical histories. 8 of these patients consented to undergo all-night polysomnography. 6 were found to have sleep apnea which was primarily obstructive in type. Recent information has implicated testosterone administration in the development of obstructive sleep apnea. Therefore, polysomnography was performed in 5 of the patients both on and off weekly testosterone injections which they were receiving to stimulate erythropoiesis. There was no change in sleep complaints or a decrease in the number of apneas and hypopneas off therapy. Sleep apnea should be considered in symptomatic male dialysis patients. Its causation is presently unknown but it does not appear to be solely related to the administration of testosterone.

    Title Potassium Secretion in the Rabbit Proximal Straight Tubule.
    Date September 1983
    Journal The American Journal of Physiology
    Excerpt

    The renal handling of potassium is generally thought to involve proximal reabsorption and distal secretion. To evaluate transport in the pars recta, we perfused S2 and S3 segments from superficial and juxtamedullary proximal straight tubules isolated from the rabbit kidney. The data indicate net potassium secretion in the isolated perfused perfused proximal straight tubule (PST). K+ secretion (JK, pmol X mm-1 X min-1) was -2.51 +/- 0.53 in superficial PST S2 segments, -2.80 +/- 1.05 in superficial PST S3 segments, and -1.36 +/- 0.84 in juxtamedullary PST. Secretion was inhibited by 10(-5) M ouabain in the bath in superficial S2 and S3 segments. When a solution resembling late proximal tubular fluid was perfused in superficial PST, JK fell from -3.86 +/- 1.77 to -0.45 +/- 0.63 pmol X mm-1 X min-1. When luminal flow rate was varied in the physiologic range in individual superficial S2 and S3 segments, JK varied directly; K+ secretion increased by -0.5 pmol X mm-1 X min-1 per 1 nl X min-1 increment in luminal flow, while collected K+ concentration did not vary significantly. When a favorable bath-to-lumen K+ gradient (10 vs. 5 mM) was imposed, K+ secretion was markedly enhanced; when an equal but oppositely directed gradient was imposed, net K+ reabsorption was observed. These data are consistent with a gradient-limited process. In midcortical tubule segments (S2 and S3), 10(-3) M amiloride in perfusate inhibited net K+ secretion from -2.77 +/- 0.52 to -0.18 +/- 1.08 pmol X mm-1 X min-1 and fluid absorption from 0.42 +/- 0.10 to 0.18 +/- 0.05 nl X mm-1 X min-1. Net K+ secretion in S2 and S3 segments of PST may contribute to previously reported K+ secretion prior to the bend of Henle's loop. The magnitude of this process in vivo is uncertain in the absence of measurements of interstitial K+ concentration in the milieu of the PST.


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