Tag: NephMadness

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A bit of NephMadness history

As I was spelunking in the depths of my hard drive I came across this document from the end of 2013. We had completed the inaugural year of NephMadness and after returning home from Kidney Week, Matt, Edgar, Kenar and myself put together a proposal to make NephMadness a recurring event.

It is remarkable that we were putting the pitch together in November and December when the contest would launch in March. Now NephMadness is a 9 month month process with planning usually beginning in June.

Some notes from the document. In 2014, we were still trying to figure out how to determine the winners. I love this paragraph, especially, “One down side of this is that it will make the contest appear rigged, which it actually is.”

I also like this part which gives you an idea of how small not only NephMadness was in 2013, but how small the footprint for online nephrology education was:

1. We were highlighted at the AJKD editorial board meeting to a geographically diverse, packed room. Dr. Levey asked how many people participated in the first NephMadness and almost no one raised their hand.

2. A day later we demonstrated NephMadness to a room of cutting-edge educators. I got the feeling, besides the usual suspects (Edgar Lerma, Pascale Lane, Tejas Desai, etc.) no one in the room had heard of the campaign. The crazy bit was, I don’t think many had heard of PBFluids.com or NephronPower.com. This really reinforced to me how limited our exposure was. We had reached out to a lot of people and had dramatically boosted the traffic to the blog but to a large extent we were preaching to the choir.

And lastly, in the publicity section we were excited about getting featured on Dr. Mike Sevillas Podcast, which has since gone defunct after 372 episodes!

So here it is for all your NephMadness nostalgia needs…

NephMadness-2.0-PitchDownload
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The Swami goes 4 for 8 and is looking for a new job

The Effluent Eight for #NephMadness are out and The Swami is not looking so hot.

Let’s break it down by region

Women’s Health Region

Swami’s Pick: Menopause and CKD

Blue Ribbon Panel’s Pick: Reproductive Planning

I still like my pick. Menopause in CKD is so poorly understood and it affects so many more people with CKD. I think this is a #BlueRibbonFail

Animal House

Swami’s Pick: Shark Maintenance of Osmolality

Blue Ribbon Panel’s Pick: Camel Water Storage

I went with what I thought was the crowd favorite, shark. This is a case where the blue ribbon panel dug in to the science and I just waved with the crowd. #SwamiSucks

Peritoneal Dialysis Region

Swami’s Pick: Volume Control in PD

Blue Ribbon Panel’s Pick: Volume Control in PD

A win.

Trial Outcomes Region

Swami’s Pick: 40% Reduction in eGFR

Blue Ribbon Panel’s Pick: Patient Related Outcomes

Interesting pick by the BRP. I can see the logic. Fair choice.

Hyponatremia Region

Swami’s Pick: US Guidelines

Blue Ribbon Panel’s Pick: US Guidelines

Another win. Two for five would get me in the Hall of Fame if I was up against major league pitching. I’m not.

Contrast Region

Swami’s Pick: Contrast is nephrotoxic

Blue Ribbon Panel’s Pick: Contrast in CKD 4

Not sure I understand the logic here. If you really think contrast is nephrotoxic, don’t you need to double down and take it over Contrast in CKD 4? If you giving contrast to a patient with a GFR of 16 ml/min, you really don’t think it’s nephrotoxic, now do you?

Pediatric Nephology Region

Swami’s Pick: Genes in CAKUT

Blue Ribbon Panel’s Pick: Genes in CAKUT

Michelle should have listened to me.

Transplantation Region

Swami’s Pick: The Untransplantables

Blue Ribbon Panel’s Pick: The Untransplantables

Nailed it.

So The Swami goes 4 for 8. Not bad, but not good enough. Thinking about moving this crystal ball on e-bay.

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You knew that proteinuria is protective against amphotericin induced hypokalemia. Right?

All of you #NephMadness players crying into your coffee about Proteinuria getting beat out by Patient Reported Outcomes need to understand that proteinuria isn’t always bad*.

*I am being sarcastic here, proteinuria is always bad, and the only reason I am writing this post is because of this interesting quirk where it appears to be protective.

Proteinuria protects against amphotericin b induced hypokalemia. In patients on amphotericin, heavy proteinuria, a protein concentration of 3 g/L (3+ on dipstick), is protective against amphotericin b induced hypokalemia.

The study was done on normal formulations (as opposed to liposomal preparations) of amphotericin B.

Amphotericin B is highly protein bound. With standard doses, the normal amphotericin concentration in the urine will be 1-2 micromol/L. With 3+ urine protein, the albuminuria concentration is over 40 micromol/L, and this is apparently enough to bind and neutralize amphotericin’s collecting duct toxicity. Amphotericin’s anti-fungal property comes from its ability to tear open fungi cell membranes. Unfortunately it does a doozy on the membranes of the collecting tubules as well, allowing potassium to flow down its contraction gradient from the cells to the tubular fluid (and out in the urine). Similarly hydrogen flow from the tubular fluid back into the cells causing metabolic acidosis. It is an unusual cause of renal potassium loss without increased aldosterone levels.

For you #NephMadness geeks, toad bladder was instrumental to working out the mechanism for amphotericin induced hypokalemia.

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I am The Swami of #NephMadness let me build your brackets and fill your pockets

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. 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 Untransplantables 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.

Now get to Tourneytopia and register to play NephMadness…Time is running out.

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Introducing #NephMadness BINGO

NephMadness is in full swing and is going strong. The NSMC interns have turned into a publicity machine cranking out the content.

This is the sixth year of NephMadness and I can honestly say it gets more fun every year. I am particularly loving this year because Anna, Tim and Matt are doing the heavy lifting as I spent most of March trekking around the Himalayas.

One of my favorite parts of NephMadness is the meta-conversation that surrounds the conversation. To honor this talk about the talk I present NephMadness BINGO.

(click for link to the PDF)

Have at it!

 

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#NephMadness Editorial in AJKD

Matt and I wrote an editorial on NephMadness. Last year was the fifth year of NephMadness and Matt and I felt it was time to pass the reigns to some new blood. Tim Yau came on board last year and got a lot of experience. Anna Burgner was added to the executive team this year. They are doing a cracking job.

As Matt and I move to lesser roles, Feldman, Dember, and Sterns invited us to review our experience with the first five years of NephMadness. It was very kind of them. The editorial is out now. Take a look.

My favorite part of this is that when you type NephMadness into PubMed, you will get two hits. (As of writing this, the new article is not indexed. Awkward.)