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In memory of Prof. Francois Berthoux (1942-2019)

Obituary for Professor François Berthoux (born on January 19, 1942 – died on February 6, 2019) – by Prof. Christophe Mariat.

"…. I have, by now, lived with this disease for more than half a century, and for more than a quarter century I have had end-stage kidney failure, undergoing dialysis and then a transplant. From the beginning, I knew it was going to be a real battle, and so I went about finding the best way to put up a decent fight. Indeed, I decided to meet this disease on its own terms… I sometimes even think that having faced such an adversity has provided me with strength more than it has been a curse…".
This interview excerpt which was included in a book entitled: “D’autres reins que les miens” (“Other kidneys, but not mine”), highlights the difficulty encountered by one of his Fellows in recounting the professional career of Professor François BERTHOUX, given that his career is closely and tightly intertwined with his life.
Professor François BERTHOUX’s career is very much part of the history of Nephrology. Indeed, leafing through the book on his professional life is equivalent to perusing the first book on Nephrology, for which the introductory chapters were written by Gabriel RICHET, Jean HAMBURGER, and Jules TRAEGER.  François BERTHOUX joined his unit at the Antiquaille Hospital in Lyon in 1964. This was a time when everything still had to be invented for this still emerging medical specialty and when all of the innovative ideas of these brazen pioneers (e.g., the first dialysis, the development of the first treatments against transplant rejection, the foundations of medical intensive care) were turned into seminal advances in Nephrology. Jules TRAEGER, François BERTHOUX’s mentor, admired him very much and often, with a certain degree of malice, confided that, out of all of his fellows, had ultimately been his favorite.
In 1971-1972, the American adventure began in Boston in the unit of, once again   another legend in the field, John MERRIL, a visionary figure and the founder of Nephrology in the United States where, in 1954, the first kidney transplant took place, which proved to be an unabated success. After this particular period, François BERTHOUX developed an unwavering fascination for medical research in the United States and in the country as a whole.

Back in France, François BERTHOUX based himself at Saint-Etienne, where dialysis, transplantation, intensive care, anatomical pathology, functional explorations, and research still needed to be established.  In essence, he created a unit based on what his mentor, Jules TRAEGER, taught him and keeping in mind  his aspirations.
When we think about François Berthoux the two main traits that shine through are his qualities as a “builder” and his qualities as a Visionary man.
As a “builder”, he went against all odds when he decided to spearhead the kidney transplant programme in Saint-Etienne, by engaging the services of a young surgeon from Lyon who had just been exposed to the basics of transplantation surgery in the unit run by Professor Jean-Michel DUBERNARD. This young surgeon, who went on to become one of the most illustrious authorities in Vascular Surgery worldwide and locally became the exponent of transplantation surgery accepted this kind offer, perhaps as a result of the residency lectures given by François BERTHOUX, but more likely because of his strong wish to tackle the challenges of human existence. In 1979, Xavier BARRAL and François BERTHOUX performed the first kidney transplantation at the CHU of Saint-Etienne, without fanfare and nearly in secret. According to the journal LE PROGRES, it is said that the hospital administration did not hear about the transplant until the day after the procedure.
A builder also of a Nephrology School which soon became world renowned, built around the fight of his life, namely IgA nephropathy.  For years, at international nephrology conferences, the three most cited cities in France were Paris, Tassin (with the Artificial Renal Center created by Guy LAURENT another “defector” of the TRAEGER dynasty)), and Saint-Etienne.
Lastly, he was a “builder”, in the real meaning of the word, when he created the ARTIC 42 dialysis association that he founded and presided over. A bona fide SME that meant a lot to him, especially because his main goal was to provide a service to patients and also because it allowed him to use his entrepreneurial skills and to carry out his "Big Projects". One of his most recent projects was the first ultra-low energy passive dialysis facility in Europe, a revolutionary concept, which has proven to be the swan song of this visionary man.

Back in the 1970s he had a vision of the importance of thinking in terms of patient populations in an era when nephrology was still based on the onerous description of individual cases. This intuition came to fruition thanks to a methodological and nearly monastic compilation of clinical data, the collection of sera and genetic material that he pursued incessantly throughout his career and that, more than 40 years later, has become one of the most extensive patient cohorts ever assembled for IgA nephropathy.
He was also considered a  visionary, in an era when the medical and scientific world in France was enthralled by the United States, when he decided, despite his affinity with the US, to focus on Europe. Several years later he became the President of ERA-EDTA and, among other contributions, chaired the very first European Guidelines for Best Practice in kidney transplantation.
Lastly, he was a visionary thanks to his ability to embrace scientific, medical, and technical advances while also refraining from the pseudo-modern trend of hyper-specialising medicine and moving away from bedside practice. According to him, nephrology was above all a clinical specialty, with a multitude of aspects, a specialty that had to resist attempts at “Balkanization” between the proponents of nephrology as internal medicine, the proponents of dialysis, and the proponents of transplantation.
For us, François BERTHOUX’s legacy is boundless, first of all in material terms but even more so at a spiritual level, in both the secular and the generic sense of the term. It involves a mindset, an expectation of excellence, an affinity for innovation, curiosity, and open-mindedness, as well as renunciation and resilience for the sake of the patient receiving treatment and care.
Today, our prayers and heartfelt thoughts, go to his children: Emilie, Nicolas, Christophe and their spouses; to his numerous grandchildren and particularly to Patricia, who has been an extraordinary wife to an exceptional man.

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