The Hyponatremia Region: Handicapping the #NephMadness 2018 Tournament

Mitchell H. Rosner

Dr. Rosner, MD, is Professor of Medicine in the Division of Nephrology and Chairman of the Department of Medicine at the University of Virginia. He has a strong interest in education and serves on a number of national committees devoted to educational aspects of medical training. He is co-director of the ASN Board Review Course. His research interests include the pathogenesis and management of disorders of sodium and water balance, the treatment of polycystic kidney disease, and the development of novel therapeutics for AKI.

What a great privilege it is to once again have a chance to handicap the 2018 NephMadness Tournament!

Let me say at the outset that anyone relying on my picks for the purpose of making any sum of money or impressing friends and family should stop reading now. I have had dismal success in the past picking the winners and I have no reason to suspect that this year will be any different.

Okay, the Hyponatremia Bracket….

First and foremost, it is about time that the organizing committee recognized this critical topic. Enough about glomerulonephritis and let’s get down to the really important stuff, the material that made us all want to be nephrologists.

We have four combatants in this region, but only three have any merit at all.

European Guidelines vs US Guidelines

Cerebral Salt Wasting vs SIADH

Let’s get cerebral salt wasting out of this bracket and just admit that this condition may not even exist.

Now, the syndrome of inappropriate arginine vasopressin secretion (SIADH) is where the smart money will land. SIADH is common, often insidious, associated with multiple etiologies and challenging to treat. Most importantly, it can negatively impact outcomes across many disease states. All in all, SIADH is tough to defend and, when on the offensive, can be lethal.

The other two competitors in the bracket are the US and European Guidelines. I have to go against my own country here and state that the European Guidelines have the edge. These guidelines downplay the role of vaptan drugs and stress a newer treatment (at least, for Americans), urea. The European Guidelines just seem more parsimonious, more nimble, and much more able to score from the perimeter.

So, when it comes down to the European Guidelines versus SIADH, I think there is no debate. SIADH will be the clear winner and will be a strong contender out of this bracket. Furthermore, just imagine a competitor that does not have to take water breaks…look out.

By the way, go University of Virginia!

– Guest Post written by Mitch Rosner

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

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