Aurélia Bertholet-Thomas

CHU de Lyon - Hôpital Femme-Mère-Enfant, Lyons, Rhône-Alpes, France

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Publications (25)79.08 Total impact

  • L. Lichtenberger-Geslin · J. Bacchetta · A. Bertholet-Thomas · L. Dubourg · P. Cochat

    No preview · Article · Dec 2015
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    ABSTRACT: Online hemodiafiltration (oHDF) is increasingly used in children; we treated 28 children since 2009, adapting this technique to pediatric patients. In this service evaluation audit, we assessed plasma electrolytes to evaluate the evolution of total (tCa) and ionized (iCa) during a session, as well as dialysate calcium (dCa) concentrations. Using a 1.25 mmol Ca/L-dialysate, both tCa and iCa decreased during the session, with iCa falling below 1.1 mmol/L in 4/5 patients. In contrast, using a 1.5 mmol Ca/L-dialysate, iCa remained normal in all patients. Major discrepancies were observed between the expected and the measured dCa: 1.25 vs. 1.01 (0.83-1.04), and 1.5 vs. 1.47 (0.85-1.75) mmol/L, respectively (results presented as median [range]). These differences were explained by the modality of reconstituting dialysate: increasing bicarbonates and/or decreasing sodium requested in the dialysate decreases calcium extraction from the acid preparation. Proof of concept was given when requesting in an "ex-vivo" setting modifications in the requested sodium and bicarbonate in dialysate directly on the Fresenius machine. Nephrologists should be aware that "high bicarbonate and/or low sodium" requirements in oHDF decrease calcium in the dialysate. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.
    No preview · Article · Jul 2015 · Néphrologie & Thérapeutique
  • S Hamo · C Freychet · A Bertholet-Thomas · A-L Poulat · P Cochat · C Vuillerot · J Bacchetta
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    ABSTRACT: Vitamin D deficiency is common in the general population and even more frequent in patients with chronic diseases. The prevention of rickets with native vitamin D supplementation is one of the oldest and most effective prophylactic measures ever reported in medicine, leading to an almost complete eradication of vitamin D-deficient rickets in developed countries. We report on two children with vitamin D abnormalities: the first, 10-year-old child developed rickets without any vitamin D supplementation despite different risk factors (autism, ethnicity, nutritional problems, chronic antiepileptic therapies). In contrast, the second, 8-month-old child received double doses of native vitamin D from birth for several months and was referred for acute and symptomatic hypercalcemia. As such, vitamin D supplementation must follow specific rules: neither too much nor too little! We also discuss the emergence of "new" genetic diseases such as mutations in the 24-hydroxylase (CYP24A1) gene inducing neonatal hypercalcemia and nephrocalcinosis: we believe that before prescribing conventional vitamin D supplementation as recommended by the national guidelines, pediatricians should quickly rule out a potential genetic abnormality in phosphate/calcium metabolism (namely a history of lithiasis or hypercalcemia) that would lead to further biological investigations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Jun 2015 · Archives de Pédiatrie
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    A. Bertholet-Thomas · B. Llanas · A. Servais · N. Bendelac · C. Goizet · G. Choukroun · R. Novo · S. Decramer
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    ABSTRACT: Tout retard de croissance staturo-pondérale conduit généralement le médecin référent à adresser l’enfant à une équipe hospitalière. Souvent, à l’issue d’un bilan complémentaire, un diagnostic est posé et un traitement instauré. Mais certaines situations aboutissent à une errance et à un retard diagnostiques qui pourraient parfois être évités dès le début de la prise en charge par un examen des urines à la bandelette (BU). Nous présentons un cas clinique illustrant l’importance de cet examen de débrouillage simple. La BU oriente rapidement vers une cause rénale (glycosurie, protéinurie), en particulier une tubulopathie proximale dont la cause la plus fréquente est la cystinose. Un syndrome polyuro-polydipsique y est le plus souvent associé et doit être soigneusement recherché à l’interrogatoire. La particularité de la cystinose est d’avoir un traitement dont l’âge d’instauration conditionne le pronostic et le délai de survenue de l’insuffisance rénale terminale. La BU devrait faire partie du bilan systématique d’un retard de croissance staturo-pondérale.
    Full-text · Article · Jun 2015 · Archives de Pédiatrie
  • S. Gaillard · L. Roche · B. Kassai · F. Abad · C. Vianey-Saban · C. Mercier · P. Cochat · A. Bertholet-Thomas

    No preview · Article · May 2015
  • T. Ginhoux · B. Kassaï · P. Cochat · S. Di Filippo · M. Rossi · A. Guyon · A. Serusclat · A. Bertholet-Thomas

    No preview · Article · May 2015
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    ABSTRACT: Cystinosis is a multisystemic autosomal recessive disorder characterized by an intra-lysosomal accumulation of cystine. It is due to a defect of cystine transport through the membrane of the lysosome. The classical infantile form is characterized by a proximal tubulopathy, corneal cystine crystals and progressive renal failure, leading to end stage renal disease before 20 years of age in 90% of cases in historical cohorts. It is the most common cause of Fanconi syndrome in children. Due to recent progress in renal transplantation and to the specific treatment with cysteamine, patients survival improved significantly in the last years and adult nephrologists take care of such patients. However, disease evolution is characterized by other complications: endocrinological (hypothyroidism, diabetes, male hypogonadism), neuromuscular and of the central nervous system. Cysteamine delays the onset of these complications. A multidisciplinary team should take care of these patients, even if the nephrologist remains in first line. Apart from infantile form, there is a juvenile form, with a later onset, and an adult form, which may be only ocular, although renal involvement may be associated. The aim of this revue is to summarize actual knowledge of the disease to provide guidance to adult nephrologist to take care of his patients.
    No preview · Article · Mar 2015 · Néphrologie & Thérapeutique

  • No preview · Article · Aug 2014 · Pediatric Transplantation
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    ABSTRACT: Background The management of tubulopathies after renal transplantation (RTx) may require high doses of sodium and bicarbonate, reducing the quality of life and therapeutic compliance of the patient. Some studies on adult patients have highlighted the benefits of fludrocortisone (fludro) in the treatment of severe tubulopathies. Methods This study was a retrospective review of the medical charts of 15 children, aged 12.4 (range 3.6–17.4) years who received fludro after RTx. Results With the administration of fludro, both sodium bicarbonate and chloride supplementation decreased, from 10 (range 0–14) to 0 (0–5) g/day, and from 9 (0–20) to 0 (0–3) g/day, respectively (both p
    No preview · Article · Jun 2014 · Pediatric Nephrology

  • No preview · Article · May 2014 · Archives de Pédiatrie
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    ABSTRACT: Introduction and Aims: A high level of fibroblast growth factor 23 (FGF23) is a risk factor for mortality, and recent studies have linked FGF23 to parameters of volume homeostasis and an increased risk of heart failure. In hemodialysis (HD), a large ultrafiltration volume (UFV) is also associated with an increased mortality risk. We aimed to investigate whether circulating FGF23 levels and ultrafiltration volume are related in a cohort of stable HD patients. Methods: Post-hoc analysis on a prospective cohort study of 104 HD patients, median age 66 (interquartile range 51-75) years, dialysis vintage 25.0 (8.5-51.2) months, who underwent a standard four-hour HD session at the first session of the week. Blood samples were drawn at onset of HD. Plasma C-terminal FGF23 was determined by ELISA. Residual renal function (RRF) and Kt/V were extracted from patient records. We used uni- and multivariate linear regression to assess the association between UFV and FGF23. Natural log (Ln)-transformation was applied when appropriate. Results: At start of the HD session the median FGF23 level was 7535 [interquartile range 3276-13433] RU/mL. Mean UFV throughout the HD session was 2561 (standard deviation ±771) mL. In univariate analysis, natural log-transformed (Ln) FGF23 levels correlated with UFV (Figure 1), and also with serum phosphate (R=0.587, P<0.001), age (R=-0.384 P<0.001), and Ln Kt/V (R=-0.252 P=0.01), but not significantly with calcium (R=0.167 P=0.09). Multivariate linear regression analysis revealed a consistent strong association between Ln FGF23 AND UFV (St. β 0.385, P<0.001), in a model adjusted for serum phosphate (Standardized β 0.451, P<0.001) and serum calcium (St. β 0.222, P=0.002; model R2 52%). Age, gender, dialysis vintage, Kt/V, systolic and diastolic blood pressure did not contribute to this model. The association between FGF23 and UFV was independent of serum phosphate (Figures 1, 2). Patients with relevant residual renal function had a trend for lower FGF23 levels (Mann-Whitney P=0.04, Spearman’s Rho -0.230 P=0.04), however RRF was no correlate of FGF23 in multivariate analysis (St. β -0.111, P=0.16). Conclusions: In a cohort of stable HD patients we found an association between FGF23 and UFV, independent of serum phosphate. Our findings are in line with the role of exaggerated sympathetic nerve activation in patients with large UFV, as it was recently reported that sympathetic stimulation increases FGF23 release from the bone (Kawai M et al J Biol Chem 2014). Further research on this novel connection between deranged volume and phosphate homeostasis in HD patients are urgently needed and may provide clues to better integrated management of these high risk patients. View larger version: In this window In a new window Download as PowerPoint Slide
    Full-text · Article · May 2014 · Nephrology Dialysis Transplantation
  • Aurelia Bertholet-Thomas · Justine Bacchetta · Velibor Tasic · Pierre Cochat

    No preview · Article · Apr 2014 · New England Journal of Medicine
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    ABSTRACT: Due to technical requirements and cost, hemodiafiltration (HDF) is not widely used in pediatrics. We have been using online HDF (oHDF) since 2009 and we observed low parathyroid hormone (PTH) levels despite the accurate management of CKD-MBD. We reviewed the medical charts and parameters of mineral metabolism assessed on a before/after session basis in the 6 children undergoing chronic oHDF in our centre. We observed low (<80pg/mL) PTH levels in all 6 patients and very low (<45pg/mL) PTH levels in 5, two of them presenting with pathological fractures. These low PTH levels were reversed after decreasing calcium concentration to 1.25 mmol/L in the dialysate, suggesting that high-efficiency oHDF may expose children to calcium during sessions in a too important amount when using 1.5 mmol/L dialysates. Last, C-terminal FGF23 levels before sessions were relatively low (<1600RU/mL), with a 32% clearance by oHDF. PTH levels should be closely monitored in pediatric oHDF and solutions with a calcium concentration of 1.25 mmol/L should be used as first line in these patients.
    No preview · Article · Dec 2013 · Néphrologie & Thérapeutique
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    ABSTRACT: Background: Rituximab (RTX) has recently showed promising results in the treatment of steroid-dependent idiopathic nephrotic syndrome (SDNS). Methods: This was a retrospective multicenter study of 18 children treated with RTX for SDNS, with a mean follow-up of 3.2 years. RTX was introduced because of side effects or relapses during therapy with immunosuppressive agents. The children received one to four infusions of RTX during the first course of treatment, and subsequent infusions were given due to CD19-cell recovery (CD19 >1 %; 54 % of children) or relapse (41 %), as well as systematically (5 %). Results: Treatment with RTX maintained sustained remission without relapse in 22 % of patients and increased the duration of remission in all other patients. The time between two successive relapses was 9 months in the absence of re-treatment and 24.5 months when infusions were performed at the time of CD19-cell recovery. At the last follow-up, 44.5 % of patients were free of oral drug therapy. Of those still receiving oral drugs, all doses had been decreased. No serious adverse events occurred. Conclusion: The results of this retrospective study confirm the efficacy and very good safety of RTX in the treatment of SDNS. The optimal therapeutic protocol seems to be a repeated single infusion at the time of CD19-cell recovery.
    No preview · Article · Jan 2013 · Pediatric Nephrology
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    ABSTRACT: Background Due to technical requirements and cost, hemodiafiltration (HDF) is not widely used in pediatrics. We have been using online HDF (oHDF) since 2009 and we observed low parathyroid hormone (PTH) levels despite the accurate management of CKD-MBD. Methods We reviewed the medical charts and parameters of mineral metabolism assessed on a before/after session basis in the 6 children undergoing chronic oHDF in our centre. Results We observed low (<80 pg/mL) PTH levels in all 6 patients and very low (<45 pg/mL) PTH levels in 5, two of them presenting with pathological fractures. These low PTH levels were reversed after decreasing calcium concentration to 1.25 mmol/L in the dialysate, suggesting that high-efficiency oHDF may expose children to calcium during sessions in a too important amount when using 1.5 mmol/L dialysates. Last, C-terminal FGF23 levels before sessions were relatively low (<1600 RU/mL), with a 32% clearance by oHDF. Conclusion PTH levels should be closely monitored in pediatric oHDF and solutions with a calcium concentration of 1.25 mmol/L should be used as first line in these patients.
    No preview · Article · Jan 2013 · Néphrologie & Thérapeutique
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    ABSTRACT: Data on long-term outcomes after pediatric renal transplantation (Tx) are still limited. We report on a 20-year single-center experience. Medical charts of all consecutive pediatric Tx performed between 1987 and 2007 were reviewed. Data of patients who had been transferred to adult units were extracted from the French databases of renal replacement therapies. Outcomes were assessed using Kaplan-Meier and Cox models. Two hundred forty Tx were performed in 219 children (24.1% pre-emptive and 17.5% living related donor Tx). Median age at Tx was 11.1 years and median follow-up was 10.4 years. Patient survival was 94%, 92%, and 91% at 5, 10, and 15 years post-Tx, respectively. Overall, transplant survival was 92%, 82%, 72%, and 59% at 1, 5, 10, and 15 years post-Tx, respectively. The expected death-censored graft half-life was 20 years. Sixteen patients developed malignancies during follow-up. Median height at 18 years of age was 166 cm in boys and 152 cm in girls with 68% of patients being in the normal range. The proportion of socially disadvantaged young people was higher than in general population. Excellent long-term outcomes can be achieved in pediatric renal Tx, but specific problems such as malignancies, growth, and social outcome remain challenging.
    Full-text · Article · Dec 2012 · Transplant International
  • P. Cochat · J. Bacchetta · J.-F. Sabot · A. Bertholet-Thomas · D. Demède
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    ABSTRACT: La lithiase urinaire est plus rare chez l’enfant que chez l’adulte, mais son éventualité doit être évoquée devant des tableaux cliniques variés, associant généralement douleur et hématurie. Cependant, il peut aussi s’agir d’une découverte fortuite. La prise en charge initiale repose avant tout sur le traitement de la colique néphrétique lorsqu’elle existe, voire sur un geste endoscopique. La nature de la lithiase est reconnue à partir de l’analyse du calcul par spectrophotométrie infrarouge, par l’étude de la cristallurie et parfois par un bilan biochimique orienté. La responsabilité des tubulopathies et des maladies héréditaires métaboliques est prédominante chez l’enfant, mais il peut aussi s’agir de lithiases infectieuses, de lithiases associées à des anomalies de l’écoulement des urines, ou de lithiases d’origine médicamenteuse. Le traitement chirurgical a cédé le pas aux méthodes endoscopiques et à la lithotritie extracorporelle et chaque étiologie guidera un traitement médical spécifique. Toutefois, la prévention de la récidive repose toujours sur la dilution des urines par l’hydratation abondante. Le pronostic dépend de l’affection causale, et notamment de l’existence ou non d’une néphrocalcinose et des éventuelles atteintes extrarénales, mais aussi de l’adéquation du traitement et de l’observance qui lui est associée.
    No preview · Article · Oct 2012 · Journal de Pédiatrie et de Puériculture

  • No preview · Article · Jun 2012 · Archives de Pédiatrie
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    ABSTRACT: Infectious risk is more important in the transplanted child than in adult because children are less often immunised against pathogens ant more exposed than adults to numerous infectious agents (virus but also bacteria including pneumococcus). The application of the standard immunisation schedule must be a permanent concern of transplantation (Tx) teams. Some vaccines that are not planned in the standard immunization schedule are particularly advised for the child and his family circle, as well as for caregivers. Immunisation response must be evaluated by a serological follow-up before Tx, in particular during the pre-Tx diagnostic work-up, then regularly after Tx. The more frequent absence of immunisation against Epstein Barr Virus (EBV) in children explains the increased frequency of post-transplant lymphoproliferative disorder at the pediatric age.
    No preview · Article · Dec 2011 · Néphrologie & Thérapeutique
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    ABSTRACT: La survie du greffon est moins bonne chez les receveurs de moins de cinq ans du fait d’un plus grand risque de thrombose vasculaire. Ces thromboses sont prévenues par le choix du donneur, la technique chirurgicale, une optimisation hémodynamique péri-opératoire et une anticoagulation préventive. La normalité de la croissance est un objectif majeur de la prise en charge des enfants transplantés. La taille finale moyenne a augmenté au cours des 20 dernières années pour se situer entre −1,63 et −0,92 SDS selon l’âge et la période de transplantation.
    No preview · Article · Dec 2011 · Néphrologie & Thérapeutique

Publication Stats

69 Citations
79.08 Total Impact Points

Institutions

  • 2013-2015
    • CHU de Lyon - Hôpital Femme-Mère-Enfant
      Lyons, Rhône-Alpes, France
  • 2011-2014
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 2011-2012
    • University of Lyon
      Lyons, Rhône-Alpes, France