#NephMadness 2018: The Effluent Eight

The first round results of NephMadness 2018 had a number of upsets. This round, the regional champions are named. Did the Blue Ribbon Panel break your heart and your bracket? Check out the Current Standings and tweet your reaction and score with the hashtag: #Effluent8


Women’s Health Region

Crowd favorites Preeclampsia’s Global Impact came out strong, but a stifling defense and a last minute 3-pointer led to another win for team Reproductive Planning.

Reproductive Planning wins 5-4.

Comments from the BRP:

We need to help women with CKD lead as normal a life as possible!

I really love preeclampsia and sFlt which went far in the 2015 NephMadness, but I think it is time to make room for women’s reproductive issues in ESRD. Is it not devastating enough to have renal failure? Add to that infertility!

Reproductive planning gets this round’s vote for me.

Preeclampsia, for its major impact on women’s mortality.


Animal House Region

Camel Water Storage showed off the depth of their bench and their ability to go 2 weeks without drinking water in this easy win over Salmon Osmolarity Balance.

Camel Water Storage wins 7-2.

Comments from the BRP:

You ever see a camel on dialysis?

“Ontogeny recapitulates phylogeny”. I remember that phrase from my invertebrate zoology professor, Dr. Bruce Holmes, 1976, one of the most interesting courses of my life. I believe it means that our evolution is still embedded in our embryology. It may not apply here directly, but the reason I bring it up is that what salmon do, imitates what we did in evolution. We left the oceans, evolved as mammals etc, then returned to the ocean, whales etc. Those are some major osmolality adaptations!
However, one of my favorite topics in clinical nephrology is clinical disorders of osmolality. Humans have evolved to be able to reasonably handle a PNa of eg 125-165, as long as it happens slowly. But a camel puts us to shame: “Dilute urine is 1000 mosm/l” (they must have Loops of Henle a foot long!), “a camel that weighs 400 kg can drink over 100 L of water in less than 5 minutes”, “as camels dehydrate over their 2 weeks without water, their Na rises from 154 to 191 mEq/L, with corresponding serum osmolality rising from 304 to 406 mosm/kg. They lose 30% of their body weight and their hemoglobin doubles.” This is truly ridiculous. Even if they spit, camels are the coolest ever.

Beauty in adaptation that challenges our understanding of salt and water physiology.

Chosen for what this animal can teach us about (de)hydration.


Peritoneal Dialysis Region

Volume Issues in PD came in heavily favored to win and did not disappoint with strong defense, an inability to miss a shot, and an excellent hydration status. They easily beat Catheter Dysfunction in PD.

Volume Issues in PD wins 7-2.

Comments from the BRP:

They are so frequently edematous!

Volume kills. PD patients tend to be more overloaded than underfilled. Easy call here.


Trial Outcomes Region

Patient-Reported Outcomes looked more awake this game than last, leading to an easy victory over 40% Reduction in eGFR.

Patient-Reported Outcomes wins 6-3.

Comments from the BRP:

The patient is the one who counts, not the investigator.

I underestimated Patient-Reported Outcomes last year. Gotta be true to myself. Still don’t get it.

Patient-Reported Outcomes: Underrecognized and under-used but a vital part of future kidney research.


Hyponatremia Region

US Guidelines with their deeper bench and wider range of skills was predicted to easily win this matchup but SIADH made it a hard win, sticking with them until the very end when U.S. Guidelines was able to pull away with the use of their trick play “DDAVP Clamp.”

US Guidelines wins 5-4.

Comments from the BRP:

How much does fear of litigation dictate the guidelines?

Thank God Cerebral Salt Wasting did not advance. “It’s a zebra, of doubtful provenance,” nicely done. US Guidelines really address SIADH, so these topics are pretty much the same. But I like the advanced thinking of the guidelines, 3% bolus therapy, DDAVP clamp. “USA, USA, USA!”

SIADH is  the most convincing argument.


Contrast Region

Crowd favorite Contrast is NOT Nephrotoxic, having already been knocked out of the tournament, shared the secret to beating Contrast is Nephrotoxic with Iodinated Contrast in CKD4, leading to an easy win for them.

Iodinated Contrast in CKD4 wins 6-3.

Comments from the BRP:

Be brave.

Contrast IS nephrotoxic, that we should have to even argue this is embarrassing. But it is overrated a bit and can be even in CKD4. Easy call.


Pediatric Nephrology Region

After an easy first round for Genes in CAKUT, GN Diagnosis made this a tough game with a tenacious defense but in the end Genes in CAKUT was still able to deliver the win by relying on their fast-paced offense.

Genes in CAKUT wins 5-4.

Comments from the BRP:

Kids’ kidneys are just small adult kidneys.

Such exciting findings in developmental biology.

CAKUT is plumbing. GN is elegant.

Having worked with a number of GN families, this is the area which would gain from NephMadness attention.


Transplantation Region

This matchup was predicted to be a close one but Virally Infected Kidneys was no match for The Untransplantables’ which looks like it is on a mission. From tipoff to the final buzzer, this matchup was never close.

The Untransplantables wins 6-3.

Comments from the BRP:

This time I give you the WHOLE sonnet, with my addition:

Not like the brazen giant of Greek fame,
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
MOTHER OF EXILES. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.

“Keep, ancient lands, your storied pomp!” cries she
With silent lips. “Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”

For I will find a way to transplant The Untransplantable!

The Untransplantables: I don’t like the term, but attending to this and using novel methods to overcome it means hope for kidney patients.


Ladies and Gentleman, your Effluent Eight!


Current Standings | NephMadness 2018 | #NephMadness | @NephMadness



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