Sweet 16 for #Nephmadness: My Thoughts

Mar 27 2013 Published by under [Medicine&Pharma]

The editors of eAJKD have narrowed the field from 32 to 16. Here are their picks:

Glomerulus

  • Medicare ESRD Benefit (1) vs PD First (14): Medicare ESRD Benefit (also my pick)
  • KDIGO (5) vs USRDS (7): KDIGO, the favorite, won, besting my pick of the USRDS.
  • Epigenetics (8) vs Propensity Scoring (6): Editors went with a bit of an upset here; I picked propensity scoring, a proven technique, over epigenetics, a promising but as yet unproven contender
  • Real Time PCR (4) vs Randomized Clinical Trial (2): RCT is the gold standard, and it wins. (also my pick)

Proximal Tubule

  • HEMO Trial (1) vs TREAT Trial (3): HEMO wins this one (also my pick)
  • ALLHAT Trial (5) vs IDEAL Trial (7): This was a tough choice, but I went with the underdog while the favorite, ALLHAT, moved on.
  • FGF23 (8) vs Anti-PLA(2)R (6): Anti-PLA(2)R is really important in membranous nephropathy, a common disease in adults. Not so common in pediatrics, so I missed this one as well.
  • HIVAN (13) vs APOL1 (2): I could not believe HIVAN won the first round; glad to see APOL1 take this match-up (also my pick)

Loop of Henle

  • Captopril (1) vs Mycophenolate Mofetil (3): ACE inhibitors rule nephrology; Captopril wipes the floor with MMF (also my pick)
  • Eculizumab (5) vs Tolvaptan (10): Seriously, what do these people see in Tolvaptan? I hope Captopril annihilates this newbie.
  • Renal Fellow Network (9) vs UpToDate (6): UpToDate takes it (also my pick)
  • ASN Kidney Week (4) vs NephSAP (2): Kidney Week for the win (also my pick)

Collecting Tubule

  • MDRD eGFR Equation (1) vs 24-hour Cr Cl (3): Equation beats collection is like the fast break taking down a half-court game, yet when in doubt we still get a 24-hour urine
  • Winter's Formula (5) vs FeNa (7): Glad to see FeNa take this round (also my pick)
  • Kidney Biopsy (8) vs Citrate Anticoagulation (11): Like anticoagulation could beat the ultimate diagnostic test (also my pick)
  • Scribner Shunt (4) vs Kidney Transplant (2): While the shunt was revolutionary and lifesaving in its time, we no longer use it. Kidney transplant, while not perfect remains the best form of renal replacement therapy and gets the win (also my pick).

The picture shows the Sweet 16 and my picks for the Elite 8, with rationale below:

Click to enlarge

Click to enlarge

  • Medicare ESRD Benefit vs KDIGO: No question in my mind; guaranteed coverage for end-stage therapy wins.
  • Epigenetics vs Randomized Clinical Trial: Unproven area of study vs the gold standard? Duh-RCT for the win!
  • HEMO Trial vs ALLHAT Trial: HEMO still guides dialysis therapy today. ALLHAT was important and affects alot of people, but the tip goes to HEMO in my mind.
  • Anti-PLA(2)R vs APOL1: The cause of membranous nephropathy vs the gene that explains the excess burden of kidney failure in African Americans can only mean one answer for me; APOL1 to the elite 8!
  • Captopril vs Tolvaptan: ACE inhibitors are the miracle drugs of nephrology. I cannot believe that Tolvaptan has hung around this long; it's time to retire that glass slipper!
  • UpToDate vs ASN Kidney Week: UpToDate clearly rules the reference rack these days, but for my specialty area I often want to know more, including recent research and the opinions of my colleagues. Kidney Week gives me all of that, as well as an excuse to hobknob with other nephrologists and talk about urine. It will be a battle, but I give Kidney Week the edge.
  • MDRD eGFR Equation vs FeNa: I did not have the eGFR equation advancing to the Sweet 16; nevertheless, I must favor it over FeNa for overall usefullness at this point in the competition.
  • Kidney Biopsy vs Kidney Transplant: Ah, the gold standard of diagnosis vs the gold standard of treatment.  I have to give the win to transplant. Even with biopsy, kidneys fail and require treatment...with transplant.

Head here to learn more about these teams and to vote for the Elite 8. Please allow my opinions to sway your vote; how has Tolvaptan made it this far, anyway???

Now for the state of my bracket:

  • Round 1:  27 out of 32
  • Round 2:  10 out of 16

What are you waiting for? Go vote!

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