Alumni Profile: Andrew Bomback'03

By Carla Cantor and Julia Hickey González

When patients meet with nephrologist and physician-scientist Andrew Bomback’03, it’s likely because they haven’t responded to the standard lines of therapy for glomerular disease—a group of rare diagnoses that impair the kidney’s glomeruli, which are the microscopic blood vessel clusters responsible for filtering waste. Glomerular disease (pronounced “gluh·mehr·yuh·lr”) is the third most common cause of kidney failure after diabetes and hypertension.

While most kidney maladies affect older patients with comorbidities, glomerular diseases often strike acutely in young and otherwise healthy individuals.

“They’re sent to me because they’re not fitting into a box, and they need some sort of outside-the-box approach to the disease,” says Dr. Bomback, an associate professor of medicine and co-director of the David Koch Jr. Glomerular Kidney Center at VP&S, which received a $20 million gift from the David Koch Jr. Foundation in 2024.

Bringing together nephrologists, kidney pathologists, and basic scientists for collaborative investigations, the Center’s ethos is a dedication to precision and personalized medicine. Its clinicians receive patients from around the country and the world, conduct the most advanced diagnostic workups (including research-grade tests not available commercially), and provide rapid access to cutting-edge therapies. Critically, Dr. Bomback and his colleagues enroll patients in clinical trials testing novel therapies under development.

“When I first got into this field, we basically had four or five medicines that we could use. They were all nonspecific and potentially toxic,” he recalls. If none proved effective after a trial-and-error approach, patients typically faced kidney failure, requiring life-long dialysis or a transplant.

Today, the landscape has shifted dramatically. Targeted therapies, including monoclonal antibodies and complement-inhibiting drugs, offer more precise, effective treatment with far fewer side effects. These advances spare patients, especially younger ones, the infertility risks of chemotherapy or the visible toll of long-term steroid use.

“Every one of the glomerular diseases over the last two decades—where we were versus where we are now—it’s remarkable,” says Dr. Bomback. “Many of our patients achieve sustained remission with normal kidney function for the rest of their lives. It’s an exciting area to work in because there are so many opportunities to get that great outcome.”

A Legacy of Leadership

Columbia has led glomerular disease research and treatment since 2000, when Gerald Appel, MD, professor of medicine and co-director of clinical nephrology at Columbia University Irving Medical Center, established the nation’s first academic program dedicated to these rare conditions. Dr. Bomback joined the program in 2009, and he became co-director with Dr. Appel in 2021, carrying forward a legacy that is now further strengthened by the David Koch Jr. Foundation.

“I like to think we were number one before the gift,” Dr. Bomback says. “The gift ensures we’ll stay at the top. We have the largest volume of patients and a tremendous research infrastructure. In nearly every clinical trial we get involved in, Columbia is usually—if not the number one enrolling site—one of the leading enrollment sites.”

For patients grappling with conditions that strike unpredictably and often acutely, the David Koch Jr. Glomerular Kidney Center provides a guiding path through complex and uncertain territory. Glomerular diseases are particularly challenging to treat because their causes are so varied. Damage to the kidney’s glomeruli can result from infections, kidney-toxic medications, genetic variants, or systemic illnesses such as lupus or cancer. In some cases, the cause remains unidentified—a condition known as idiopathic glomerular disease.

A central aspect of Dr. Bomback’s work is offering hope and innovative solutions to patients through clinical trials that pave the way for groundbreaking treatments. In addition to conducting research, his role has a strong clinical dimension as he carefully oversees each patient’s journey: reviewing medical histories, performing advanced diagnostics, guiding them through treatment protocols, and closely monitoring their progress at every stage.

Dr. Bomback approaches each case with four fundamental questions each patient is asking him in some way: What disease do I have? Why did it happen? What is the likely outcome? And what are the best treatment options? “The research we conduct at the Center is designed to answer all four of those questions,” he says.

A Trusted Partner in Leadership

Dr. Appel, a renowned kidney researcher celebrated for his pioneering work on the renal manifestations of systemic lupus erythematosus and other glomerular diseases, first met the clinician who would become his co-director when Dr. Bomback joined VP&S as a glomerular disease fellow in 2009.

“When Andy came to us, he was already exceptionally well-trained in clinical nephrology, having completed his residency at UNC—one of the premier programs for glomerular diseases, second only to Columbia,” Dr. Appel says. “But what set Andy apart wasn’t just his solid foundation. It was his remarkable drive, dedication, and energy. He reminded me of myself in my younger years—never turning down an opportunity and tackling every task with efficiency and focus.”

Dr. Appel recalls how quickly Dr. Bomback distinguished himself during his fellowship, excelling in both research and patient care. “He was incredibly productive, publishing numerous manuscripts, and patients absolutely loved him,” he says.

When Dr. Bomback decided to stay at VP&S as an assistant professor, Dr. Appel saw it as a defining moment for the glomerular program. “From the start, it was clear Andy had all the qualities we’d want in a leader—an exceptional clinician who connects deeply with patients, a top-tier researcher, and he even has a gift for fundraising,” he says. “If I ever needed a nephrologist, Andy would be my first choice without hesitation. And when the time comes for me to step back, he’s the one I trust to carry the program forward and build on what we’ve accomplished.”

A Circuitous Route to Nephrology

Dr. Bomback’s path to medicine was not entirely straightforward. As an undergraduate at Harvard, he majored in Classics, intending to earn a doctorate and pursue a career teaching at a university. His father, Fred Bomback—a pediatrician and revered VP&S faculty member for 36 years, who still teaches as an emeritus professor—supported his aspirations but encouraged him to take a few premed courses as a backup. That practical advice ultimately proved pivotal.

By his third year of college, Dr. Bomback began to rethink his future. “My passion for Classics had started to fade,” he says. “Medicine offered a rare opportunity to engage in intellectually stimulating academic work and be of service to others,” he says. “That was the path I knew I wanted to follow.”

Initially, he considered family medicine. During his early years at VP&S this seemed like a natural fit—until a nephrology rotation in his fourth year shifted his perspective. “I had the privilege of having Qais Al-Awqati, one of the greatest kidney physiologists of all time, as the attending in my consult elective,” he says. “John Crew, director of the VP&S Transplant Fellowship, was the fellow on consults during that elective, too. So, I saw the best of Columbia nephrology. It was inspiring, and these incredible mentors made me realize just how exciting and rewarding the field could be.”

The defining moment, however, came during his second year of residency, when he received an invitation to attend the American Society of Nephrology meeting, an opportunity extended to residents who had expressed an interest in the specialty. “At some point during that meeting, I called my then-girlfriend, now wife, and said, ‘I think I’m going to go into nephrology,’” he recalls. “Over a weekend, I went from one of the broadest medical specialties to a highly specialized field—and later, to a subspecialty within a subspecialty.”

There was also a more personal connection that may have drawn him to nephrology. When Dr. Bomback was about six years old, his grandfather developed an acute kidney injury caused by bilateral kidney stone obstruction and required dialysis. The nephrologist who treated him was Dr. Gerald Appel, the same physician who would later become Dr. Bomback’s mentor and co-director.

“My grandfather recovered and came off dialysis, but Jerry remained his doctor for years,” Dr. Bomback says. “In our family, he was spoken of almost reverently. He functioned as more than a specialist—he was like a primary care doctor for my grandfather, and his opinion carried enormous weight.”

Years later, during his second year at VP&S, Dr. Bomback attended one of Dr. Appel’s lectures on glomerular disease. Seeing him in that role for the first time left a strong impression.

Now, decades later, Dr. Bomback works alongside the physician who shaped his family’s story in such a profound way. “It’s remarkable to think that the doctor who cared for my grandfather has been my mentor and colleague for the past two decades,” he says.

Medicine, Music, and Lifelong Connections at VP&S

His time at VP&S shaped not only Dr. Bomback’s professional development but also his personal life, fostering friendships that continue to influence him today. Among his fondest memories are the nights he spent performing with an indie rock band made up of fellow medical students. The group played at coffeehouses and at rooftop parties, tackling challenging songs with intricate arrangements. “We picked difficult pieces like Belle and Sebastian’s ‘This Is Just a Modern Rock Song’ and Smog’s ‘Hit the Ground Running,’ knowing we had exceptional musicians,” he says. “One of my classmates had gone to Juilliard before medical school. We had high-level singers and amazing violinists.” While he viewed himself more as a producer than a musician, Dr. Bomback enjoyed being part of the group. “I could sing a bit and play simple guitar songs, but I wasn’t the one contributing to the musicianship. For the most part, I was there for the music and the fun.”

The connections he made during those years remain strong, forming a network of trusted peers he regularly turns to for insight and collaboration. Many of his classmates are now colleagues at Columbia, and their bonds extend beyond work.

“There are about a dozen people from my class who are now at Columbia. One of them, an associate dean, recently led the white coat ceremony for my nephew,” he shares. “I still meet up with my VP&S classmates regularly, and I even discuss challenging cases with them. The school did an incredible job of helping us build not just professional relationships, but lifelong personal ones as well.”

Building the Future of Disease Care

When the David Koch Jr. Center was announced in August 2024, Dr. Bomback received an outpouring of congratulations from his VP&S classmates, many now scattered across the country. Their support highlighted the reach and importance of the Center’s mission. One of its most critical goals is preparing the next generation of experts to lead advancements in glomerular disease care and research.

Next year’s glomerular disease fellow, Natasha Freeman (VP&S’20), exemplifies this mission. After completing her residency at Yale, Dr. Freeman was accepted into Columbia’s nephrology fellowship program, and in July, she will begin a second fellowship in glomerular diseases, working closely with Dr. Bomback and his team at the Center.

He looks forward to their collaboration. “I was one of Natasha’s mentors on a research project. She was a brilliant student, winning a graduation prize at VP&S for top research in nephrology,” Dr. Bomback says. “It’s an exciting time for the program to have her back with us.”

The David Koch Jr. Foundation’s transformative gift is helping to drive this excitement and ensure that the program’s work continues to push boundaries. With enhanced resources, the Center will tackle ambitious projects, such as studying IgA nephropathy sub-phenotypes and long-term outcomes with new immunosuppressants, employing systems genetics to uncover mechanisms of glomerular injury, and exploring how sex and age influence treatment responses. These efforts will deepen collaborations with Columbia experts in fields like epidemiology, biostatistics, structural biology, and genomics, refining data analysis and advancing understanding of disease progression.

Beyond research, the gift will expand access to specialized care for patients worldwide, establish a dedicated fellowship program to train the next generation of specialists, and launch a patient advocacy initiative to help guide individuals through their treatment journeys.

“Some glomerular diseases may only affect 100 people in a city like New York,” Dr. Bomback notes. “But as the Center grows, we can draw patients from across the nation and the world. With a larger pool—1,000 patients instead of 100—we’re far more likely to identify genetic signals or other patterns that could lead to breakthroughs.”

As the Center advances treatment and research, its mission remains steadfast: to unlock the mysteries of glomerular disease and ensure no patient is left without answers.

“One of our primary goals is to remove the term ‘idiopathic’ from the literature,” Dr. Bomback says. The Center, he adds, is focused on identifying the underlying causes of glomerular diseases, whether genetic, autoimmune, malignant, allergic, or toxic.

“While some cases still defy explanation, that’s the challenge the team is committed to solving,” he says. “By pushing the boundaries of what’s possible we aim to give patients access to a future that was once unimaginable—one where kidney failure isn’t the expected outcome and sustained remission is well within our reach.”