How are you doing after the first round of NephMadness 2022? In this round, the region champions are named. Did the Blue Ribbon Panel keep you alive or break your heart and your bracket? Check out the Current Standings and tweet your reaction and score with the hashtag: #NephMadness

We present the Effluent Eight:

Current Standings | Match Results | #NephMadness | #EffluentEight

And before we start, huge thanks to Omar Taco @ErrantNephron for the scoreboard graphics!

Lupus Region

After a strong showing to make it to the Saturated 16, Belimumab fell flat and their shots just weren’t falling. Family Planning in Lupus Nephritis showed that coming in with a good game plan can make all the difference in the game with the easy win. 

Family Planning in Lupus Nephritis wins 14-7

Comments from the BRP:

“The increasing use of antibody therapy is revolutionizing how we treat many diseases. Finding the right target seems to be the trick. They might have it here.”

“I lose more lupus patients to unplanned pregnancy and complications. Belimumab is a distant dream!!”

“Sickest patients I have ever seen are pregnant lupus patients-period. We do not address family planning enough.”

“Family planning emphasizes the needs to maintain the patient and their values at the heart of medical care.”

“I am uncertain of the value added of belimumab in terms of cost and impact. But the family planning discussion affects many women with disease and while not “new” I think a reminder of the issues is important and impactful.”

“Great pick – when you may have limited choices it’s always preferable to know what they are.“

Animal House Region

Crowd favorite Team Giraffe’s height proved no match for Team Bear’s hibernation skills (and ability to come into this match well-rested). Team Bear wins a close match in regulation time to move on to the Effluent Eight. 

Bear wins 12-9

Comments from the BRP:

“I come back to my comment on the regulation of vascular function through that long neck!!”

“Hibernating bears lose no lean body mass because amino acids enter protein synthetic pathways at increased rates producing reciprocal decreases in entry into the urea cycle. As urea is hydrolyzed, the released nitrogen combines with glycerol to form amino acids which can be used to synthesize proteins – how can you beat that? The geekiest of nephrologists loves this stuff!”

“Could you imagine the giraffe Euro-step around the bear?”

“I hate, hate, hate winter and wish I could hibernate through it like a bear, recycling my N2 into new protein and getting all my water from metabolism and then NOT voiding for months.”

“The bear beats the giraffe not so much on beauty but on its remarkable efficiency.“

Hemodialysis Region

Despite its low energy, Team Intradialytic Hypotension continues to make forward progress in this tournament. Team Middle Molecules fought a good fight but in the end just weren’t able to get their shots to fall. 

Intradialytic Hypotension wins 13-8

Comments from the BRP:

“This is the most common complication, always has been. We still don’t have the answer so any further inroads are welcome.”

“Our understanding in maintaining hemodynamics through the challenges of fluid removal offers a huge opportunity to improve dialysis safety and care.”

“Anyone that knows me knows I am obsessed with middle molecules and the middle molecule theory of uremia. This is why a lot of (diffusive only) dialysis is only so good and a yet a little GFR goes so much farther (or is it further?)”

“I believe Middle Molecules are important but there wasn’t any clear mention of what is new here and so I defaulted to Intradialytic Hypotension due to its impact on outcomes.”

“More to do here – unpleasant, dangerous, and perhaps not a completely intractable problem?“

Inequities Region

Governmental Policies kept pace with Social Determinants of Health but a strong full court press by the latter led to their victory. 

Social Determinants of Health wins 12-9

Comments from the BRP:

“We can do something about this at the local level.”

“Poverty beats all.”

“I believe strong federal policies limiting inequalities across the US rather than decentralizing processes by state is most impactful.”

“From the top, we need our policymakers to do more to focus on CKD – they can be the leaders and changemakers we need to change lives.”

“Governmental policies have consistently failed when confronted with social determinants of health.“

Parasites Region

Malaria’s streak from the 3-point line continues. Schistosomiasis could not figure out a good defense. The question is, can Malaria be stopped?

Malaria wins 15-6

Comments from the BRP:

“To borrow and paraphrase a well-known book title, ‘The Emperor of All Parasitic Diseases.'”

“Loved the part on male menstruation-because schistosomiasis was so common.”

“Too many deaths still.”

Cardiorenal Region

Diuretic Resistance Treatments continues its Cinderella run with another resounding win. Does anyone still think they are an underdog with this win over Kidney Biomarkers in CHF?

Diuretic Resistance Treatments Wins 16-5

Comments from the BRP:

“We will not make headway into the treatment of cardiorenal until we figure out what we are actually treating!!

“Biomarkers – overused, overplayed, overhyped.”

“New and creative ways of managing volume overload promise effective care for many of the most challenging cases.”

“I’ll bet kidney biomarkers advances. Anything biomarker is hot these days, but I just love the physiology of diuretics and their resistance.”

“This is an excellent discussion and I hope participants take advantage because this is one of the more common issues we deal with.”

“Despite the well-placed tweet from the very funny @drglaucomflecken (!! – more of this please) still going for diuretic resistance treatments…”

“Great topics but I think learning the treatment strategies is most meaningful.”

Neonatal Region

Nephron Number and CKD‘s lack of a deep bench led to Novel Devices for Neonatal HD pulling ahead in the last 5 minutes of this game for the win.

Novel Devices wins 12-9

Comments from the BRP:

“If we can figure out how to grow more nephrons, we will have it made.”

“Devices can be in my hands!”

“I was weaned on the Brenner hypothesis, but I bet devices advances. People love technology.”

Nephropath Region

The first nail biter of the tournament. Other Membranous Antigens and IgG4-Related Disease took this game to double overtime. After trading the lead several times, a buzzer beater by Other Membranous Antigens from midcourt led to a hard fought W. 

Other Membranous Antigens wins 11-10

Comments from the BRP:

“This remains so much of a mystery. We are going to figure out what the basic underlying pathophysiology is. And we will learn much about immune-mediated disease.”

“Too many other…and so many that we do not yet know.”

“IgG4 disease is sneaky, with so many moves that it can get to the rim right under your nose.”

“As a path guy this is tough, it was ‘eeny meeny miny moe’ here.”

“This choice is completely influenced by the horrible effect of this disease on families and friends I have met along the way.”

Current Standings | Match Results | SaturatedSixteen

#NephMadness | @NephMadness

Reminder:

US-based physicians can earn 1.0 CME credit and 1.0 MOC per region through NKF PERC (detailed instructions here). The CME and MOC activity will expire on June 1, 2022.