Student loans…credit card debt…car payments
I can make them all disappear.
In previous years I couldn’t prognosticate on NephMadness because I was contaminated by running the Blue Ribbon Panel. This year I have have no such inside knowledge. I am free and I am going to share the wisdom I have gained by running the previous BRPs to give you can’t-miss-locks.
In previous years there has always been prohibitions from any type of gambling
But in 2018, AJKD forgot to ban gambling. So call your bookie! Mortgage the house! Cash in the kids’ 509 college plan! I’m going to whisper the winners. These darlings are your chance for a better life!
We are going to skip the Satuated Sixteen and go right to the regional champions.
The Effluent 8:
Women’s health
Menopause is the dark horse here. Everyone is going to go with reproductive planning because when a dialysis patient gets pregnant everyone goes crazy. But the issue that affects almost all of our female patients is menopause. This is seriously under-studied and it’s going to cut throught this region like a knife through butter. This is a bracket buster and when it beats reproductive planning on March 31st, #NephTwitter is going to be out for blood. You won’t be crying because your going to pick menopause right now.
Animal House
No bracket busters here. This is going total chalk. Pick Shark like everybody else. Getting cute with camel or toad is just going to make you poor. Shark FTW.
Peritoneal Dialysis
This is going to be a tough call, and I’m worried that the Blue Ribbon Panel could make a mistake here and foolishly go with PD catheter dysfunction but the answer is Volume Issues. Volume Rules.
Trial Outcomes
This one is easy. It is 40% drops in GFR. Nephrologists have been telling people not to perseverate over the creatinine for years. We told them eGFR was a better estimate than any serum creatinine. We have been calculating eGFRs for 20 years. The fact that the FDA is still looking at doubling of creatinine is a travesty. An eGFR based trial outcome is long overdue. 40% loss of eGFR destroys this division to advance to the Elite 8.
Hyponatremia
The US Guidelines are a juggernaut. Ignoring the placebo-controlled trials supporting Vaptans while prescribing your patients urine pills supported by a few observational trials is knocking on homeopathy’s door.
Contrast
NephMadness is innovative but there is no way nine nephrology leaders are going to go on the record and say contrast is not nephrotoxic. This is easy, Contrast is Nephrotoxic cruises to the win here.
Pediatrics
Genes in CAKUT. There are no pediatricians on the BRP. They are going to go full science when faced with this question. Don’t doubt me. This one is a lock.
Transplant
The Untransplantables is going to win this one. Best name. Best science. No contest.
The Filtered Four
Menopause versus Shark
Animal House was fun, but up against Women’s health it will be treated as the gag region that it was meant to be. Menopause walks all over Shark. Sorry.
Volume issues versus 40% drop in eGFR
Redefining the primary outcome of every major CKD study for the next 20 years is going to be unstapable.Β 40% drop in eGFR FTW!
The US Hyponatremia Guidelines vs Contrast is Nephrotoxic
My crystal ball gets a little cloudy here. Guidelines are a little dull and the BRP may not want to advance them to the Filtered Four, but at the same time, I suspect they will be looking at how thin the data on contrast being actually nephrotoxic and will feel a bit guilty. The US Guidelines advance here.
Genes in CAKUT vs The Untransplantables
No contest. The peds topic is dropped like a dirty diaper. The Untransplantables advance
The Filtered Four
Menopause vs 40% drop in eGFR
This is the year World Kidney Day was devoted to women’s health. Menopause takes that momentum and rolls over Drops in eGFR of 40%.
US Guidelines vs The Untransplantables
The US Guidelines have navigated to the final four by finding a weak stream of competitors. They have no reason to be there. They are The Loyola Ramblers and Sister’s Jean’s run is about to run out. The UntransplantablesΒ rips up the guidelines.
The Left and Right Kidney
Menopause versus the The Untransplantables
Everyone loves transplant, and transplant always wins.
Your NephMadness champion will be The Untransplantables.
I finished the hike with Ben, Jen, and Ellen. We finished with headlights. Eleven hours. A rolling hike with a total descent from 15,000 to 11,000 feet with two significant climbs. A fine end to a fine trek through the Himalayas.
During the hike we got to see Everest peak over a ridge of mountains that normally obscures it. Like I said, perfect weather. As we hiked up the left side of the lateral moraine of the Kumbu glacier, it became apparent we were hiking into blind canyon. I knew that Everest climbs started by climbing through the Kumbu ice fall, but it was unclear where that went. Eventually it became apparent that the glacier took a turn to the right and there was a hidden gap in the wall that led up the mountain to camp one. Once that geography became clear my eyes knew where to look for Basecamp and could pick up the prayer flags.
I’m not entirely sure, but I think the wedding dress is from 
Love your kidneys
CJASN and Everest Basecamp
Silva and Jeff had a touching moment where they dedicated the climb to the loved ones they lost and then drank some home-made Raki and poured some out. Before long, English Paul and Bishnu were calling for us to wrap it up and hike back to Gorek Shep.
The Lobuche Helipad
We had some fluffy white clouds chasing us up the mountain all day.
Gorek Shep in all of its glory (with helicopter)
The hot shower? Fake news.
loading the stove with dried yak dung. The tea houses would only have a stove going in the evening. Since we were going to be there during the day, we had to pay them a few hundred rupees to light the stove early.
Note the lateral moraine to the right of me.
The town of Dhugla is like two buildings and one of them is an outhouse. This is where we were headed for lunch. It looks close but we had to navigate quite a boulder field, cross a river and renegotiate another boulder field to actually get there.
Why would you be nervous about that bridge?
Jen with Eddie in the background.
Both the stream and the boulder field were glacial detritus and were a good hint of the afternoon to come. For lunch we had noodle soup in at auxiliary room and then we moved into the main dining room for warm chapati, and peanut butter and honey. More than a few cans of Pringles were purchased.
Noodle soup.
Still life with lemon tea and OMD-EM10
How eggs get up the mountain: On the back of a porter. After seeing this I stopped complaining about the price of breakfast.
They told us to drink lots of water.
Lobuche was one of the trashiest Tea Houses we stayed at.
Only Sherpas smoke at altitude.
Rhodedendron Forrest. Just like the Smokeys.
We cruised down from Tengboche until we hooked up with the Dudh Cosi, the river which drains the Kumbu Ice Fall (The Ice Fall is the first obstacle after leaving Basecamp when climbing Mount Everest). It was a cool hike and for a long time that morning we were able to look over our shoulder and see Tengboche. We passed a collapsed bridge from the 
We crossed on a higher bridge. It was an exciting bridge crossing. I have enjoyed all of them except for that famous double bridge. That one was just too high for me. This one was fine. As the group started crossing the bridge some yaks started crossing from the other side so some of us turned around (hence the people facing both ways on the bridge picture above). We cruised until about 1:00 and came in for a well deserved lunch. It was a vegetable soup called Sherpa’s Stew. We ate it in a cool tea houses. All of the tea houses have a eating area that has windows on three sides with great views.
At 14,000 feet when the wind begins to blow its gets cold fast. Note: Corrugated Steele Guy in the background.
The graffitti you see in the Himalayas is…different.
Plastic cups are light and don’t break. Perfect for Himalayan Tea Houses, but Peter Rabbit?
Crossing the Dudh Cosi (again)
The kids on the trail were cute.
Ama Dablam
Solar powered tea kettle warmer could boil water, possibly helped by the high altitude. We saw these reflectors everywhere.
The hike into Dengboche
Clouds over Dengboche. Almost every afternoon we had clouds roll in, at higher altitudes this usually meant hiking in the mist.
Popcorn a staple snack in the tea houses. Who knew?
Checking vital signs in Dengboche.
The other cute feature of the bathroom is that the toilets don’t flush. There is an 80 gallon drum of water and a coffee can floating in the water. After you do your business, you simply flush the toilet by pouring water into the toilet. This took me more than a few moments to figure out.
After a few hours we stopped for a tea break. Zonder broke out the chili spiced dehydrated mango. This is an amazing hiking food.
