#NephMadness 2021: The Effluent Eight

How are you doing after the first round of NephMadness 2021? This round, the regional champions are named. Did the Blue Ribbon Panel keep you alive or break your heart? Check out the Current Standings and tweet your reaction and score with the hashtags: #Effluent8 #NephMadness

We present:

Current Standings Match Results | Saturated 16 | #NephMadness

Liquid Biopsy Region

Microscopy Techniques dominated this game, showing that without a mastery of the fundamental skills, Urine Microscopy for GN wouldn’t even have a team. This was a blow out win for Microscopy Techniques as they dribbled circles around the competition  

Microscopy Techniques Wins 7-2

Comments from the BRP:

I can’t proceed without a urine microscopy report.

Technique wins out – without technique you can’t see the dysmorphic RBCs and RBC casts.

Microscopy techniques are the foundation–including urine micro for GN.


Animal House Region

Team Seahorse’s lack of glomeruli proved no match for Team Hopping Mouse’s superpower of conserving water. Easy win for the Hopping Mouse. 

Hopping Mouse wins 6-3

Comments from the BRP:

The ability to provide a maximally concentrated urine runs laps around the aglomerular nephron.”

I just can’t move past this little creature’s ability to concentrate its urine down to a solid.

This was tough. Although the concentration skills of the hopping mouse are admirable, my vote goes to the aglomerular seahorse who also can see in all directions.


COVID-19 Region

There was a lot of excitement surrounding Glomerular Injury in COVID-19 coming into this matchup, however the lessons learned by COVID-19 in Dialysis in this past year caused them to really grow as a team and led to an easy win for them! 

COVID in Dialysis wins 7-2

Comments from the BRP:

COVID in Dialysis: More common problem with larger numbers.

We know that ESKD is a risk for COVID but tubular injury is affecting many more and the understanding of etiology is impactful.

A close contest, but the lessons learned from this pandemic will hopefully translate to improved practices in infection prevention in dialysis for the long-run.


ICU Nephrology Region


Dialysis Timing in Surgical ICU is out to prove they belong in this tournament and played a solid game leading to the win over Dialysis with ECMO.

Dialysis Timing in Surgical ICU wins 6-3

Comments from the BRP:

When to start KRT in AKI is the biggest question, with data favoring a delayed approach in patients without an objective indication.

“Dialysis Timing in Surgical ICU: Seems the most likely to impact on long term CKD outcomes.”

“Time is kidney. Sort of.”


Workforce Region

Academia proved that they are nothing without Medical Student Interest and Medical Student Interest’s youth and enthusiasm led to a slam dunk victory for their team. 

Medical Student Interest wins 7-2

Comments from the BRP:

Increasing medical student interest in kidney physiology and kidney disease will drive the long-term viability of nephrology as a specialty.

“Fundamentally think our efforts for the med students will have long lasting ‘dividends’.

I believe the children are our future, Teach them well and let them lead the way.

This was SO hard to choose. But the pipeline is essential to all things–including academia. And that starts with med students.

It is critical that the pipeline for students be increased. I’ve spoken at the STARS Luncheon several times. Today’s students have a great interest in patient engagement.”


Anemia Region

Despite being a crowd favorite to go all the way in this tournament, HIF Stabilizers came out flat on their feet and almost lost to Oral Iron. Oral Iron got into foul trouble early in the second half and free throws led to a HIF Stabilizers victory. 

HIF Stabilizers wins 5-4

Comments from the BRP:

HIF inhibitors improve iron kinetics, beating our iron supplements in a blow-out.

I’m tired of talking iron…..

Early, judicious use of oral supplements are an affordable and effective way to stave off the use of more expensive methods and should prolong kidney function for those in early CKD.

“HIF HIF hooray!”

“All topics are important, but anemia is so prevalent among CKD patients. Current treatments are insufficient for patients. An oral treatment (which CMS has not approved) is a treatment of choice.”


Primary Care Region

This highly touted match didn’t disappoint the viewers. The game was closely matched until the final minutes when CKD Primary Care was able to pull away with a couple of spectacular 3 point shots.

CKD Primary Care wins 6-3

Comments from the BRP:

Improved detection in management of CKD in primary care is what is needed to bend the curve (using better, and racially unbiased, equations for estimation of GFR).

The re-examination of formulae fundamental to our field is the most impactful issue in PCP right now.

Early and effective management of CKD should slow its progression and on a population level this will reduce the morbidity of kidney disease and the number of patients requiring kidney replacement therapy.

“This bracket that has me the most conflicted. It is my two top picks and they are going against each other. Easily either could be the winner. Educating our Primary Care colleagues on how to best care for kidney patients is paramount and would have immediate benefit to our patients. However, It is also time to re-examine the formulas we have taken as gospel and try to do better. I think the time is right for GFR in CKD!”

“One of the primary things that concerns me as a general internist is CKD in Primary Care.”

“Early identification is the key to improving kidney care and achieving the goals in the Advancing American Kidney Health Initiative.”


Artificial Kidney Region

This was a close matchup between the two up and coming teams of AWAK – Wearable PD and Implantable Bioartificial Kidney. After double overtimes, a last second half court shot put Implantable Bioartificial Kidney up by one to win the game!

Implantable Bioartificial Kidney wins 5-4

Comments from the BRP:

I’m on the list, seriously AAKP works extensively with Drs. Roy and Frissell. My last words to them – the experts said it was impossible to create a vaccine for COVID-19 in less than 3 years. Stay the course!

Both are exciting developments, and hopefully both will come to fruition, but AWAK seems to be closer to having an impact.

AWAK leads in the short term (5-10 years); an implantable bioartificial kidney will be the long term solution for the management of kidney failure.

Although AWAK is super exciting and likely very relevant for large swathes of the world’s population with CKD, I can’t get past the excitement of the implantable bioartificial kidney. I was a paediatric trainee in 2004 working in endo and nephro. The dialysis scripts I write 17 years later are essentially the same – where diabetes has moved from multiple daily injections to wearable glucose monitors and insulin pumps! The potential for change is massive!

NephMadness 2021 | #NephMadness | @NephMadness

How to Claim CME and MOC
US-based physicians can earn 1.0 CME credit and 1.0 MOC point for reading this region.

  1. Register/log in to the NKF’s Professional Education Resource Center (PERC). If you select “Physician” in the drop-down menu during registration, the ABIM ID will pop up – make sure to complete this during registration to receive MOC points after course completion.
  2. Review the activity, disclosure, and accreditation information.
  3. Click “Continue” and review Course Instructions.
  4. Complete Post-Test. Please note: By selecting “Yes” to the participation questions for each region, the corresponding Post-Test questions will appear. Click “Save Draft” to save your responses and finish later. When you are ready to submit your answers, click “Preview” to review all responses, then click “Submit.”
  5. Click “Next” to complete the Evaluation form, then click“Submit.”
  6. Claim 1.0 CME credit and 1.0 MOC point per region (up to 8.0 total for 8 regions of NephMadness).
  7. Save/print your certificate.

The CME and MOC activity will expire on June 14th, 2021.


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