NephMadness 2015: Obstetric • First Round Results
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The Obstetric and Nephrology Region was a mixture of routes and close games. The panelists were impressed with the field, one was overheard mumbling, “Those OBs may be way out ahead of us. God-bless the database – can be more powerful than the RCT.”
sFlt1 in Preeclampsia versus Podocyturia in Preeclampsia
Winner: sFlt1 in Preeclampsia
Top seeded sFlt1 thought it was going to cruise through the opening round of NephMadness, but the freshman squad on Team Podocyturia came to play. Riding off there miraculous 100% sensitivity and 100% specificity the Podocyturians jumped out to an early lead. But the sFlt1 is not a team that is easily put down and they quickly found their footing, started making defensive stops and crawled back into the game. By the final TV timeout, The sFlt1s had the game well in hand. The panelists were impressed with the match, “Podocyturia is very cool diagnostically, but SFlt1 has real therapeutic implications.” And to the victor go the spoils!
ACOG BP Goal < 160/110 in PE versus Lower BP Goal in Preeclampsia
Winner: ACOG BP Goal < 160/110 in PE
ACOG came in hot after their recent road win at the NEJM center. This was just a rematch and you could tell that the Lower BP targets in PE couldn’t get their rhythm. The ability to avoid severe hypertension, thrombocytopenia and elevated liver enzymes point to important biologic effects to lowering blood pressure. But in the end the current guidelines ability to deliver healthy babies to healthy women ruled the day.
CKD due to preeclampsia versus preeclampsia due to CKD
Winner: CKD due to preeclampsia
When the selection committee put this match-up together they had high hopes for a tight match of these two conference rivals. However the Blue ribbon Panel would have none of this and they went 7-0 for CKD due to preeclampsia. Could this be a hint of future success in the region? We will have to wait to find out. The panel went with the weight of evidence showing prolonged, subtle kidney injury from preeclampsia. This is consistent with the current message that AKI leads to CKD (data be damned).
Pregnancy in Dialysis versus Pregnancy in Kidney Transplant
Winner: Pregnancy in dialysis
This was a tight contest, another 4-3 split where any judge could have the contest the other way. While there is little doubt that maternal and fetal outcomes are superior in transplant, the long wait for a kidney paired with the narrowed procreational window of CKD makes this difficult road to execute. On the other hand the improvement in fetal and maternal outcomes in ESRD is impressive. This is a field where prolonged dialysis hours is remaking our stereotypes of pregnancy in dialysis. One of the panelists was overheard saying, “There’s something about pregnancy in dialysis that, when it is successful, is just amazing. It’s the kind of thing that the people of the dialysis unit remember forever.” Pure magic.
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