#NephMadness 2017: The Filtered Four

Posted on March 31, 2017 by AJKDblog in NephMadness // 0 Comments

We are closing in on the NephMadness 2017 champion! If you’ve missed the other results, here are the links to the Saturated16 and Effluent8 posts. The Filtered Four are listed below – tweet your reaction and score with hashtag: #NephMadness

Glomerulonephritis vs History

After handling the Glomerulonephritis region, Anti-PLA2r did not miss a beat and made quick work of the History of Nephrology champ, History of Hemodialysis.

Anti-PLA2r wins 8-1.

Blue Ribbon Panel comments:

In 4-5 years, identifying antibodies causing human diseases will be a means of permanently curing those diseases, as tools to knock out those and only those specific antibody-producing cells will be at hand. Finding PLA2r as a target will mean the end of membranous nephropathy – someday.

Playing for the future – not the past.

Crunch time. Now the decisions get hard. My two finalists made it in this round: Hx HD and Anti-PLA2R. I gave a Grand Rounds on the history of HD years ago, and found video of both Scribner describing his shunt and Kolff describing early HD. Amazing stuff. We take HD for granted, but it is amazing technology. Still, this PLA2R story is about as good as it gets for GN – I’m so glad it beat Steroids for IgA, a topic that makes me nauseous (makes me nauseated? gives me nausea? nauseates me? I can never get that straight). The Hx of HD is the UCLA in the 70s, untouchable history but just not that exciting lately. Hx of HD is the pick and roll, PLA2R is a slam-dunk on the fast break. PLA2R it is.

Dialysis vs Biomedical Research

The Dialysis champion, Patient-Reported Outcomes, smoked Kt/V and may have been a bit cocky, but the young team from Dialysis ran into late foul trouble and CRISPR-Cas9, the Biomedical Research champion, outlasted them in a tight and physical contest.

CRISPR-Cas9 wins 5-4.

Blue Ribbon Panel comments:

PROs are today.

I don’t see CRISPR being stopped. They’re doing more this week than last week.

This is a very tough decision. Genetics tools will lead to breakthroughs and understanding of disease and treatment. Things that matter to patients will help us help the thousands (hundreds of thousands) of current patients on dialysis or near to it. I want both!

Patient-reported outcomes advanced twice and I haven’t voted for it once. I did pick CRISPR and it advanced. Maybe it is a pipe dream, but the potential of this technology is scary. Some people book their trip to Mars, I’m booking my trip to CRISPR to fix me up. I suspect it will advance easily.

Disparities vs Genetics

The Disparities in Nephrology champion, Genes in ESKD Disparity, has been shocking the crowd with its victories in the first two rounds. The scrappy Disparity crew continued to find ways to win. This time, the victim was the Genetics champion, Podocytopathies. Genes and disparity continues to just win.

Genes in ESKD Disparity wins 6-3.

Blue Ribbon Panel comments:

Genes in ESKD Disparity is playing offense like we haven’t seen before. Can anyone match up with these guys?

I picked these two to advance, but I’ll bet the voting was a close call. I love anything genetics and evolution and picked Genes in ESKD over System factors in Tx. Zebrafish v Podocytes was almost a toss-up but I picked podocytopathies since they more clinically relevant and not rare at all, and more and more are identified each year. I gotta stick with evolution – Genes it is by a tie-breaking free throw after the buzzer.

Diabetes vs Nutrition

The young guns of the SGLT2 inhibitors were just coming off their emotional win over ACEi to take the Diabetic Nephropathy crown when they came up against the Nutrition champion, Microbiome and the Kidney. In a close match that went to overtime after a desperation 3 at the end of regulation by Microbiome, the SGLT2i finally overcame the microbiome.

SGLT2 inhibitors in Diabetic Nephropathy wins 5-4.

Blue Ribbon Panel comments:

I still want to eat during HD.

Hard to know where microbiome information will go but SGLT2 inhibitors may be a real game-changer.

Microbiome is just starting to realize their potential. Watch out as the Dance moves on.

ACEi/ARB lost to SGLT2i. In retrospect I am not surprised. I picked ACEi/ARB but I think I was biased having been involved in the initial trials. ACEi/ARB is a basket with an “and-one” for three, SGLT2 is a three-point swish. Feeding on HD is a very cool topic, especially since it is not intuitive, but the microbiome is limitless in what we may learn. SGLT2i is the MarchMadness on your iPhone; Microbiome is MarchMadness on a large screen HD TV with surround sound. Go Microbiome!