NephMadness 2014 • Toxins • First Round Results

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Aristolochic Acid versus Hemoperfusion

Winner: Aristolochic Acid

It was a senior class of alkylation, mutation and profibrogenesis that propelled Aristolochic Acid to a decisive first round victory over Hemoperfusion. Now considered to be one of the leading causes of CKD in China and Taiwan, Aristolochic Acid was completely resistant to all forms of defensive adsorption and binding attempted by Hemoperfusion. Using a new “undeclared” player strategy, Aristolochic Acid secretly put extra toxins on the court without checking in at the referee table and notifying Hemoperfusion. As these toxins were not obvious because they weren’t listed on the standard player personnel sheet, Aristolochic acid pummeled Hemoperfusion relentlessly. Hemoperfusion was limited in its availability and became too saturated as the game went on to continue at a continuous high level of play. This new “undeclared” strategy and the direct toxicity of Aristolochic Acid puts them in a formidable position to advance beyond the second round.

Toxic Metals versus Fomepizole

Winner: Fomepizole

This is why the game is played on the court and not on paper! An early favorite to advance, Toxic Metals clearly overlooked the enzymatic potential of their opponent, Fomepizole and were eliminated in the first round. Fomepizole exposed the weakness of Toxic Metals as having a one dimensional offense focusing almost exclusively on the proximal tubule. In contrast Fomepizole demonstrated a wide variety of versatility being able to inhibit the metabolism of multiple alcohols: ethyl alcohol, ethylene glycol, methanol, isopropyl alcohol, and propylene glycol. In addition, toxic metals proved vulnerable to the metallothionein defense which is widely available to all opponents. Fomepizole proved that indeed money can buy the best team and now heads into the second round with momentum and confidence.

Glycyrrhizic Acid versus Chelation Therapy

Winner: Glycyrrhizic Acid

In the most exciting game of the first round, Glycyrrhizic Acid came back from a huge first half deficit to shock Chelation Therapy at the buzzer. From the first tipoff, Chelation Therapy bound their way to a quick lead. EDTA, DMSA and BAL combined to leave nothing “free” on the court and it appeared that Chelation Therapy was poised to cruise into the second round. But then after halftime, as time passed, the avidity of Chelation Therapy began to wane and dissociate. Glycyrrhizic Acid took full advantage of this momentum shift and attacked the Na-K ATPase pump repeatedly. With the game tied and only seconds remaining, Glycyrrhizic Acid called a timeout to map their final play. Inbounding into the serum, Glycyrrhizic Acid quickly entered the cytoplasm and set up the perfect screen on 11-betahydroxysteroid dehydrogenase completely neutralizing it. This allowed the “backdoor play” to materialize as cortisol came off the bench and rushed untouched straight into the aldosterone receptor and sealed the victory. A true ESPN top 10 play of the day! Glycyrrhizic Acid, the crowd favorite, moves on to inhibit another day in the tournament!

DSHEA versus Osmolar Gap

Winner: DSHEA 1994

As expected, DSHEA 1994 proved that even after 20 years, it remains the most important factor influencing the sale, control, and advertisement of Alternative Medicines in the US. Osmolar Gap put up the best effort it could but it has a complex mathematical formula to remember on calculating serum osmolality and a dependence on the ordering of additional tests: measured serum osmolality made it slow and unable to keep up with DSHEA 1994. In addition, Osmolar Gap proved too nonspecific and a variety of toxic and nontoxic alcohols constantly tricked it. As a last gasp effort, the Osmolar Gap even tried to bring in 2 new players, the FDA and Congress, off the bench but DSHEA 1994 wasn’t deterred at all and continued it’s powerful permissive role in the favor of all the manufacturers of herbal and vitamin supplements. DSHEA 1994 may require the election of  a brand new House of Representatives and Congress in order to derail it’s anticipated march into the finals.

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