It’s time for our first step on the road to naming a Champion, announcing the winners of each of this year’s regions! Is your The mighty Blue Ribbon Panel has conferred, and the picks are in.  Will it be a cause for despair or celebration? Check out the Current Standings and tweet your reaction and score with the hashtag #NephMadness

We proudly present:

Current Standings | Match Results |  @NephMadness | @nephmadness.bsky.social

Many thanks to Krithika Mohan @krithicism for the scoreboard graphics!

IgA Nephropathy Region

Highly touted Team Complement Inhibitors didn’t even show up to play. Team B-cell Modulators with the easy first round victory.

B-cell Modulators wins 8-1

Comments from the BRP:

“Such a clear winner. Targeting the production of pathogenic IgA is the holy grail, and the B cell data is super encouraging. Complement inhibition is a downstream target that isn’t to be scoffed at, but the prospects are more exciting for diseases like C3GN, or if B-cell therapy is ineffective.“

“Anti-BAFF and -APRIL are true game-changers. Complement is clearly important in IgA, but inhibiting the BAFF and/or APRIL pathways has the potential for a cure of IgA. With the elimination of hematuria, massive reduction in proteinuria, and above all the stabilization of GFR slope, in the future, we may not even need ACEi/ARBs or SGLT-inhibitors! We are on the verge of a true and lasting complete remission. Much different than 2023 NephMadness when conservative care beat out immunosuppression for IgA.”

“Team B-cell modulation! Play defense early, Target IgA nephropathy at its source, which may translate into a more effective disease-modifying strategy.”

“More upstream; have a greater potential I believe for cure.”

“Denervation has been the disappointment that just keeps disappointing. It is time to get better medications and the scouting report has promising rookies. Some of them show real BP reduction promise, not that piddly 4-6 mmH Hg that is so bleh to the resistant HTN we deal with. Meds for the win.”

“Exciting times for IgA nephropathy, B cell targets seem most promising at the moment, but likely next 2 years will see complement in next neph trials.”

Artificial Intelligence Region

These two hotly talked about newcomers to the tournament did not disappoint! It was a close match up but Team Natural Language Processing was able to wear down Team Computational Pathology and walk away with the win.

Natural Language Processing wins 6-3

Comments from the BRP:

“While AI is infiltrating healthcare on all fronts, fields like radiology and pathology that rely on pattern recognition are where we are going to see it’s complementary effects first. Can AI do a first pass on slides and identify sclerotic glomeruli, and then validated by a pathologist – yes. But if AI replaces words and communication, it takes away personalism and humanism in medicine.”

“What seems to be common among all of the studies is accuracy of diagnosis in real time. At this juncture, Artificial Intelligence seems to be that which can accomplish that need with precision. Also, because of the nature and effectiveness of this tool, a more in-depth analysis beyond the scope of the natural eyes and interpretation of results seems to be more dependable for the best treatment and perhaps in some cases prevent progression because of early detection.”

“Why did you become a physician? Would you recommend the next generation, or even your own child, to become a doctor? Most now say “no.” I would argue that we became doctors to care for people, help humanity, and have a comfortable work-life balance while doing so. In other words, enjoy our time on earth while also improving it…a worthy profession for the future. But countless hours of EMR documentation was a jarring realization that became the main barrier to our goal. Remove the barrier with NLP? Hell yes. NLP for the win. Let our children enjoy being physicians.”

“While computational pathology is super cool, NLP has the potential to absolutely make life a heck of a lot easier as a clinician and several facets of this technology is already rapidly being rolled out!”

Animal House Region

Team Cats‘ independence proved no match for Team Dogs‘ loyalty! Team Dogs with the easy win.

Dogs wins 6-3

Comments from the BRP:

“TBH – I voted Dogs before I even read the write-up because I’m a dog person. Then I read the region, and still felt like dogs won the matchup. Absolutely no confirmation bias present at all.”

“Comfort to human being, dual partnership, reliable and dependable.”

“Is this a joke? If cats win I will ‘bow’ out of BRP next year. Dogs should dominate.”

Trolls of Transplantation Region

This matchup of  two veterans in the transplantation region did not disappoint. After a double overtime, Team BK edged out Team CMV with the last second buzzer beater. 

BK wins 5-4

Comments from the BRP:

“Toughest matchup so far but CMV edges this one out – it just seems more nasty, causes more problems, and there’s more to think about with the pretransplant eval. As a general nephrologist who doesn’t deal with txplant, learned a ton about both of these from this writeup!”

“Significantly, is its multifactorial interplay, between donor, recipient, and transplant characteristics. Interestingly, is its overall intensity of immunosuppression that remains the single, strongest determinant.”

“Team BKV because we still have no game plan outside of reducing immunosuppression, while CMV is becoming increasingly manageable with available antivirals.”

C3G Region

This tough match up did not disappoint but in the end Team C3G Treatment‘s new treatment options proved to be too much for Team C3G Diagnosis on the court. 

C3G Treatment wins 6-3

Comments from the BRP:

“I HATE the old MPGN terminology (which encompassed C3GN) with a passion and am so glad we moved away from that. Having more serologies to assess the complement pathway other than C3 and C4 would be nice, but it looks there’s still so much variability. Treatment however has firm results for both iptacopan and pegcetacoplan that are super encouraging, so treatment wins easily here.”

“I’m interested in the reshaping of the trajectory by testing new therapies to manage kidney transplantation.”

“Team diagnosis in C3 glomerulopathy because it’s a notoriously difficult diagnosis with major therapeutic consequences.”

“These treatments are revolutionary and I’ve seen firsthand the difference that they have made in the patients my colleagues and I care for! The evidence in the groundbreaking trials speaks for itself.”

Cerebronephrology Region

This hard fought game came down to a last second foul by Team Cerebronephrology in CKD leading to two nothing but net free throws and the win by Team Cerebronephrology in ESKD. 

Cerebronephrology in ESKD Wins 5-4

Comments from the BRP:

“This one is tough – I’m tossing a vote for ESKD because I found the studies looking at dialysis and cerebral blood flow and ICP to be more interesting.”

“Significant to me is the close relationship between the brain and the kidney, known as the Brain Kidney axis. I am curious to know how cognitive impairments such as dementia affects the kidney and whether at some point early diagnosis by AI can result in early brain treatment, thereby sparing the kidneys.”

“Tough one. great scouting reports, please read them! But CNS changes in ESKD is paramount for the nephrologist to understand, recognize, and treat. ESKD for the win.”

POCUS Region

This first round has been full of tight match ups, including this one. Team POCUS in AKI and Team POCUS in ESKD traded the lead multiple times, but a last second slam dunk by TEAM POCUS in AKI led to the win!

POCUS in AKI wins 5-4

Comments from the BRP:

“Another tough decision but going with AKI by a hair here. I wouldn’t be mad with either team winning though.”

“As much as POCUS seems to give all of the answers, the data is not yet there. It certainly should be an adjunct to the care of nephrology, and likely more helpful in ESKD>AKI.”

Genetics Region

These two strong teams made for an exciting tournament game. But in the end Team Fabry Treatment could not keep up with Team PKD Masquaraders‘ ability to hit the 3 pointer. 

PKD Masqueraders wins 6-3

Comments from the BRP:

“While interesting to read, I got PTSD back to 1st year medical school from reading all the genes in the PKD region. I thought the Fabry’s region was going to be boring and just talk about Fabrizyme, but I learned a ton about the newer enzyme, SRT, and chaperone therapy, which was super interesting, so easy win in this matchup.”

“I learned so much from the scouting reports of both regions! thanks to the authors. Tough call here, but given how common PKD is compared to Fabry, it should dominate.”

“Team PKD masqueraders! Genetic studies are showing diverse phenotypes that look like PKD but play very differently, and recognizing them changes how we manage the game.”

Current Standings | Match Results

#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, 2026.