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The Brackets


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The Brackets


To succeed in the tournament you will need to know everything about the concepts. You can find all the data here and on eAJKD. We will also be tracking outside websites with reliable information and  the results on this page.

What's up with the seeding?

Unlike rational tournament design, we have the best match ups right in the first round, that makes for some odd and non-sensical seeding. Don't worry about it.

The 8 regions

Instead of 4 regions of 16, we have 8 regions of 8. Each region covers a different aspect of nephrology. Each one had a content specialist that participated on the selection committee. Here are the regions and their dedicated committee member:

  1. Toxins: Warren Kupin
  2. Hypertension: George Bakris
  3. Renal replacement therapy: Glenn Chertow
  4. Regeneration: Stuart Shankland
  5. Acute kidney injury: Sarah Faubel
  6. Electrolytes: Helbert Rondon
  7. Kidney Stones: David Goldfarb
  8. Biologics: Jonathan Hogan
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Toxins


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Toxins


This bracket consists of 4 international teams that represent the most lethal of all the nephrologic insults counterbalanced by 4 teams that define the best defensive strategies against renal injury. Led by Aristolochic Acid, Toxic Metals and the much vilified and maligned DSHEA 1994 (Dietary Supplement Health and Education Act of 1994), fans will have to choose between political, oxidative, and pro-malignant offensive powerhouses versus defensive specialists utilizing adsorption, chelation, and enzyme inhibition game plans.  Is the best offense a good defense or is the best defense a good offense?

Get the scouting reports for all 8 teams in the toxin bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the toxin region.

Click the eAJKD logo to go to in depth information about the toxin region.

Additional resources that may help you with your brackets:

This Joel Topf's recent grand rounds on the subject. He based the lecture on Warren Kupin's Toxin lecture that he gives at the ASN Board Review Class and also gave at Kidney Week 2013.

Joel Topf at his Precious Bodily Fluids blog did a post on recent data from the Czech Republic on dialytic management of methanol toxicity published in this month's Kidney International.

Joel Topf at his Precious Bodily Fluids blog did a post on recent data from the Czech Republic on dialytic management of methanol toxicity published in this month's Kidney International.

NephMadness 2014 Part 2 - Poisons and Toxins Bracket

Brief summary of DSHEA and a bit on glycyrrhizic acid.

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Hypertension


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Hypertension


With the last minute addition of the highly controversial JNC 8, this pressure-packed bracket now appears to be one of the most competitive in the tournament. Much anticipated dream matchups included in the first round pit thiazide vs thiazide (HCTZ vs Chlorthalidone), manometry reading vs manometry reading (Systolic vs Diastolic) and guidelines vs guidelines (KDIGO vs JNC 8) in non-stop pulsating action. Perennial fan favorite and systemically dominant ACEi/ARB leads the way but with a stroke of luck there very well could be a Cinderella team emerging from this bracket.

Get the scouting reports for all 8 teams in the hypertension bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the hypertension region.

Click the eAJKD logo to go to in depth information about the hypertension region.


NephMadness 2014 Part 1: Hypertension Bracket by Andrew Malone

Links to the Symplicity trials and a couple of links to JNC-8 and the minority opinion that was published afterwards.

Some community generated resources for this bracket

Dr. Topf reminding everyone that ALLHAT was a negative trial, and everyone pointing to reduced CV outcomes with chlorthalidone is relying on secondary outcomes, a questionable statistical meneuver in negative trials.

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Renal Replacement Therapy


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Renal Replacement Therapy


This bracket offers teams from the past, present, and hopefully the future of research projects and therapeutic options in the management of acute and chronic renal failure. The glaring omission of transplantation from this section has resulted in a potential planned boycott of this bracket by transplant nephrologists. However, as 90% of patients receive dialysis prior to transplantation and over 90% of nephrologists are not transplant physicians, the steering committee has respectfully declined to change the seeds, citing the irrelevance of this vocal minority group.  It's going to be a spirited and competitive contest of physiologic principles and access techniques matched against research proposals. Who will achieve maximum clearance and filter their way to the championship?

Get the scouting reports for all 8 teams in the renal replacement therapy bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the renal replacement therapy region.

Click the eAJKD logo to go to in depth information about the renal replacement therapy region.

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Regeneration


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Regeneration


Not to be confused with the concept of “resurrection,” this secular bracket holds no religious affiliation and preaches the concept of renewal through re-directional maturation and re-birth. Each candidate team has established itself scientifically as having the potential for a lead role in reparation of kidney injury. You don’t have to be a regular subscriber to Nature or have an R0-1 grant to appreciate the remarkable replicating metamorphosis skills of each member of this bracket. Which cell line will transition its way to the championship of this group?

Get the scouting reports for all 8 teams in the Regeneration Bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the regeneration region.

Click the eAJKD logo to go to in depth information about the regeneration region.


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Acute Kidney Injury


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Acute Kidney Injury


These competitors will surely challenge each fan’s loyalty to nephrology tradition for both seasoned professionals and those in their rookie years. Extra security has been brought in to ensure that game time emotions are appropriately diuresed and kept under pH control, especially for the International matchup of KDIGO vs KDOQI AKI guidelines, the potentially acidic battle between Saline and Balanced Solutions, and the playoff round of old (Traditional urinary indices) vs new techniques (Urinary biomarkers)  for diagnosing AKI. Not to be overlooked among all this controversy is the king of AKI, CIN (Contrast Induced Nephropathy), which may very well prove to be too overwhelmingly nephrotoxic to be seriously challenged by any of the other teams.

Get the scouting reports for all 8 teams in the Acute Kidney Injury Bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the acute kidney injury region.

Click the eAJKD logo to go to in depth information about the acute kidney injury region.

NephMadness 2014 Part 4 - AKI Bracket

Discusses remote ischemic pre-conditioning.

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Electrolytes


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Electrolytes


This is a highly charged bracket of teams all trying to balance, bind, or buffer their way to the title. For those fans that miss the science lessons in "Breaking Bad," there are representative teams from all parts of the periodic table in addition to organic and inorganic synthetically derivative molecules and mathematical formulas. Arch rivals in the treatment of acute hyponatremia, Hypertonic Saline and Vaptans, square off in a first round osmotic demyelinating showdown of epic tonicity! As if that wasn't enough osmoles for one round, there is the battle of the Gaps, a duel of K+ sequestrants and topped off by a bicarbonate battle that will go likely down to the last proton. Let's get ready to rumble!

Get the scouting reports for all 8 teams in the Electrolyte Bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the electrolyte region.

Click the eAJKD logo to go to in depth information about the electrolyte region.

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Kidney Stones


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Kidney Stones


Trying to choose the winner of this bracket is like finding yourself between a rock and a hard place! So many strong teams that precipitate intense emotions from the fans. This bracket sports the sensational matchup in the first round of two stone legends: Pak vs Coe the veritable Bird / Magic rivals of nephrolithiasis. In addition, the controversial role of internists vs surgeons in treating stone disease will crystallize also in an exciting first round game. Fans will find that it is going to be a painful, colicky passage through each round eliminating quality opponents until the champion is either passed spontaneously, dissolved, or basketed.

Get the scouting reports for all 8 teams in the Stone Bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the stone region.

Click the eAJKD logo to go to in depth information about the stone region.

On Thursday Joel Topf lead a Twitter chat with a group of urologists looking at the stone bracket. You can see a collection of the best tweets here.

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Biologics


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Biologics


This state-of-the-art section would not have existed 5 years ago. Replete with FDA approved and FDA not approved, humanized, synthetic or chimeric, monoclonal, polyclonal, or fusion antibodies or receptors, this group represents an immunologic cornucopia and a semantic and enuciating challenge. Spanning subcutaneous and intravenous routes, these agents run the gamut from the most expensive drug in the world, Eculizumab (more than the price of a 2014 fully loaded Lamborghini Aventador), to a still-in-research-phase but recently patented soluble CR1 receptor. The future of medicine is here in this bracket and one of these teams may very well bind their way to the final four.

Get the scouting reports for all 8 teams in the Biologics Bracket at eAJKD.

Click the eAJKD logo to go to in depth information about the biologics region.

Click the eAJKD logo to go to in depth information about the biologics region.

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The use of Eculizumab in transplantation: What’s new? by Adela Mattiazzi

A sharp review of the various off label uses of eculizamab in transplant. I love it when a blog has a reference from a 1 month old journal articles. Renal Fellow Network, more up to date than UpToDate.