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Comptes Rendus
Chimie
Dominique Joly and Michel Daudon
Tribute to Paul Jungers (1932–2022)
Volume 25, Special Issue S1 (2022), p. 7-9
Issue date: 1 September 2022
https://doi.org/10.5802/crchim.215
Part of Special Issue:Microcrystalline pathologies: Clinical issues and
nanochemistry
Guest editors:Dominique Bazin (Université Paris-Saclay, CNRS, ICP, France),
Michel Daudon, Vincent Frochot, Emmanuel Letavernier and Jean-Philippe
Haymann (Sorbonne Université, INSERM, AP-HP, Hôpital Tenon, France)
This article is licensed under the
Creative Commons Attribution 4.0 International License.
http://creativecommons.org/licenses/by/4.0/
Les Comptes Rendus. Chimie sont membres du
Centre Mersenne pour l’édition scientifique ouverte
www.centre-mersenne.org
e-ISSN : 1878-1543
Comptes Rendus
Chimie
2022, Vol. 25, Special Issue S1, p. 7-9
https://doi.org/10.5802/crchim.215
Microcrystalline pathologies: Clinical issues and nanochemistry / Pathologies
microcristallines : questions cliniques et nanochimie
Tribute to Paul Jungers (1932–2022)
Dominique Jolya andMichel Daudon ∗, b
a Necker Hospital, Paris, France
b Tenon Hospital, Paris, France
E-mails: dominique.joly@aphp.fr (D. Joly), daudonmichel24@gmail.com (M. Daudon)
Issue date: 1 September 2022
Originally from a modest family in Lorraine, he
said that from a very young age he learned a culture
of work and dignity.
“My vocation was inspired by the enthusiasm I
had felt for Pasteur’s brilliant discoveries, during nat-
ural science classes in the final years of high school.
I was fascinated by the logic that demonstrated the
inanity of the theory of spontaneous generation, and
by the discovery of the principles of immunity and
their application to vaccination. I admired Pasteur’s
willingness to devote his discoveries to the service of
mankind and the courage it had required of him to
take the risk of vaccinating, thereby defying all con-
ventions and prohibitions... Pasteur represented for
me a model of scientific requirement, and passion
for caring, that corresponded to my aspirations; this
confirmed my vocation to undertake medical stud-
ies.”
Having graduated Major of the PCB of Nancy, he is
admitted as a scholarship holder to the Cité Univer-
sitaire and begins his medical studies in Paris.
“During my first two outpatient internships in
the surgical departments of the Necker Hospital, I
took advantage of the proximity of Professor Ham-
burger’s department to follow his wonderful weekly
∗Corresponding author.
visit, where his scientific and humanistic approach to
medicine influenced me deeply.”
“It was my good fortune to be accepted as an in-
tern from the outset, then as clinic head (1961–1970),
and finally as an associate. I had the privilege of
living through all the stages of the nephrology ad-
venture, from the advent of medical resuscitation to
the beginnings of acute renal failure treatment by
the artificial kidney, chronic renal failure by periodic
hemodialysis, and finally to the continuous improve-
ments in the conservative treatment and prevention
of chronic renal failure.”
During his 40 years at Necker Hospital, Paul
Jungers developed an eclectic research programme.
He published numerous books and books’ chapters
and more than 300 publications in the most presti-
gious journals. His dynamism was contagious: it ben-
efitted several generations of interns, clinic heads,
doctors in the process of specialization, residents
from all parts of the world, and doctors from asso-
ciated dialysis centres: as soon as he spotted good
will and expertise he initiated scientific collaborative
work.
The common thread of this monumental labour?
“To benefit patients without delay by applying cut-
ting edge therapeutic advances as and when they are
made.” Most studies have led to tangible therapeutic
applications. Among the main therapeutic topics ad-
dressed are:
ISSN (electronic) : 1878-1543 https://comptes-rendus.academie-sciences.fr/chimie/
8 Dominique Joly and Michel Daudon
• Hepatitis B. Paul Jungers described the epidemi-
ology of hepatitis B incidence in patients and care-
givers in haemodialysis units, and coordinated the
national randomized trial of an Institut Pasteur vac-
cine. Colleagues had to be convinced of the need for
a prospective randomised trial, which by definition
puts half of the participating subjects at risk of con-
tamination without treatment. The national ethics
committee convened on this occasion validated the
principle of the trial, attracting unanimous support.
From 1981, vaccination enabled the gradual eradica-
tion of hepatitis B in dialysis and resuscitation units,
and its prevention in the general population.
• Treatment of severe forms of lupus nephropa-
thy. In an evaluation (led by JF Bach) in 32 patients,
supplementation of corticosteroids with cyclophos-
phamide significantly improved the remission rate of
severe forms of lupus nephropathy.
• Pregnancy in lupus patients. Epidemiological
studies, conducted with Maxime Dougados, François
Tron, Frédéric Lioté and Pascal Houillier, established
the conditions necessary for favourable foetal and
maternal pregnancy outcomes in women with lupus
nephropathy. Collaboration with the Necker Hospital
endocrinology department defined the principles of
hormonal contraception so as to avoid exacerbation
of the disease.
• Pregnancy issues in women with nephropathy.
Pregnancy was not recommended at the time in
women with kidney disease. Considering that the as-
piration of motherhood is legitimate for any woman,
and that this (in effect) prohibition was not based
on rigorous proof, Paul Jungers undertook an epi-
demiological study, with the help of Pascal Houillier
and Dominique Forget, in more than a thousand pa-
tients, pregnant or not, with kidney diseases of all
types. This study established the optimal conditions
of planned pregnancy leading to successful live birth
without exacerbating maternal nephropathy. In ad-
dition, a case-control study of 360 women with dif-
ferent types of primary glomerulonephritis demon-
strated that pregnancy by itself does not increase the
risk of progression to renal failure when kidney func-
tion is initially normal or close to normal. These stud-
ies, the findings from which have been universally
confirmed and adopted, have enabled many women
to fulfil their desire for motherhood.
• Treatment of chronic uremia by keto-analogues.
From 1982 the possibility of slowing the progression
of uremia by using a preparation of essential amino
acids lacking their alpha-amino groups was inves-
tigated with Philippe Chauveau. This approach en-
abled a substantial delay in the initiation of replace-
ment dialysis in many patients, an important objec-
tive at a time when the number of dialysis stations
was still very inadequate. This nutritional approach,
restrictive and difficult to comply with, was aban-
doned in France when sufficient dialysis stations be-
came available, but was made available again a few
years ago.
• Highlighting and contrasting the adverse conse-
quences, in patients with chronic renal failure, of late
initiation of dialysis management, with the benefits
of early nephrological follow-up.
• Evaluation of the respective indications, for re-
placement dialysis or conservative treatment, and
their consequences, in very elderly subjects with ad-
vanced renal failure.
• Highlighting, with Philippe Chauveau and Malik
Touam, the atherogenic role of hyperhomocysteine-
mia in chronic renal failure, and the possibility of cor-
recting it with oral folic acid (with the complemen-
tary benefit of enhancing erythropoiesis).
• Study of immune dysregulation induced by the
uremic state, in particular highlighting the increase
in the plasma level of pro-inflammatory cytokines
(TNFα and IL-1β) and advanced oxidation proteins
products (AOPP) responsible for oxidative stress con-
tributing to atherogenesis, with Béatrice Descamps-
Latscha and Lucienne Chatenoud.
• Epidemiological demonstration of a threefold
higher incidence of atherothrombotic accidents in
dialysis and predialysed renal insufficiency, charac-
terizing accelerated atheroma, and analysis of risk
factors for atheroma in uremics, leading to the con-
cept of the importance of cardioprotection in these
patients, with NK Man, Ziad Massy, Thao Nguyen-
Khoa and Gérard London.
• Comprehensive epidemiological survey on the
incidence of end-stage renal failure treated with re-
placement dialysis in Ile de France in 1998, which
served as a pilot study for the development of the na-
tional “REIN” programme (Epidemiology and Infor-
mation in Nephrology Network).
• Complete revision, with Michel Daudon, of the
concepts around the exploration and medical treat-
ment of urolithiasis, both in its common and severe
hereditary forms, and development of new practical
Dominique Joly and Michel Daudon 9
rules adopted since by the entire uro-nephrological
community. Paul Jungers was very early interested
in the concept that among the common chemical
compounds of kidney stones, namely calcium ox-
alate, calcium phosphate or uric acid, crystalline
phases within the same chemical species were more
important to take into account to understand the
cause of the stones. He was always eager to under-
stand the precise causes of lithiasic pathologies to
propose the most suitable treatment for each pa-
tient. With regard to calcium oxalate, which is the
most common chemical species of kidney stones,
Paul Jungers was quickly convinced of the clinical in-
terest of distinguishing between crystalline species
and pathology and in particular of the privileged
links between whewellite and urinary oxalate on the
one hand and weddellite and urinary calcium on
the other. He was a strong advocate of the morpho-
constitutional analysis of urinary calculi by physi-
cal methods at a time when chemical analysis was
still very widespread. Very attentive to detect as
early as possible the causes of lithiasis, especially
from genetic origin, likely to have deleterious con-
sequences on kidney function, he has greatly con-
tributed to raising awareness in the urological com-
munity of the importance of exploring lithiasic pa-
tients very early from the first stone manifestation.
Thanks to his unwavering commitment, practices
have gradually evolved for the benefit of patients.
Paul Jungers also understood early on that two cal-
culi of the same crystalline composition could have
very different structural characteristics, therefore dif-
ferent morphologies that signed in an even more
specific way the pathology involved in the lithia-
sic process. This approach has proven to be par-
ticularly effective for the early diagnosis of genetic
pathologies such as primary hyperoxaluria or dis-
tal tubular acidosis or acquired diseases such as
Sjögren syndrome. This relationship between pre-
cise (non-dietary) cause and stone morphology was
then extended to other clinical contexts such as
inflammatory bowel diseases, bariatric surgery or
chronic diarrhoea sometimes responsible for very
active lithogenic processes that can impair kidney
function.
Paul Jungers was also a remarkable, passionate
and captivating teacher. His didactic works on lithi-
asis, Chronic Kidney Disease, and dialysis, regularly
republished and updated, have trained and continue
to train generations of French-speaking nephrolo-
gists.
Respected and admired, but far from intimidating,
Paul Jungers was very close to the nursing staff, as
well as an empathetic clinician, truly listening to pa-
tients during his consultations and during hospital-
izations. Ahead of his time, he understood the impor-
tance of comprehensive and not exclusively technical
patient care for kidney disease.
“Starting from the principle that it is not only up to
the patient to adapt to the treatment, but also for the
treatment to adapt to the patient, it seemed essential
to me to individually adapt therapeutic prescriptions
to conditions of lifestyle and activity, family context,
and patient age, and to pay the greatest attention to
their morale and concerns. My greatest reward was to
see many patients, who approached our consultation
with reserved and anxious faces, leave with a smile,
assured that all possible measures were implemented
to delay the deadline for dialysis and allow them to
lead as normal lives as possible.”
An accomplished researcher, teacher and physi-
cian, Paul Jungers was a role model for many. Those
who had the chance to work alongside him loved
this enthusiastic man, teeming with ideas, insightful,
tenacious, and upright and demanding certainly, but
also warm, attentive and available.
In 2012, Paul Jungers received with emotion the
Jean Hamburger Medal of the Society of Nephrol-
ogy. These words bring together the French and
French-speaking nephrology family to pay tribute
to him.
Our thoughts are with his widow, Mrs. Suzanne
Jungers, his children Mr. and Mrs. Olivier Jungers,
Mr. and Mrs. Pierre-Yves Jungers, and his grandchil-
dren, Pierre, Victoire, Bryan, Lara, and Nicolas.
Dominique Joly
Michel Daudon


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