#NephMadness Choosing Wisely Campaign (#NCWC) –Women’s Health Region (#WomensHealthRegion)

Blog Post


From ‘Prematurity’ to ‘Menopause’, life completes a full cycle in the Women’s Health region of Nephmadness 2018. Let it be the glomerular disease (preeclampsia) or dialysis & transplant (reproductive planning) or endocrine disturbances, this region has something for everyone, including our pediatric colleagues. The fact that all of the players in this region are of vital importance makes the choice even more difficult. 

For me, all are champions in their own way, but let’s try to peep into minds of #Blueribbonpanel (BRP) who will have the final word in crowning the champion. The fact that we have 6 wonderful ladies (out of 9 members) on the BRP is a testimony to the fact that this region is going to make it big.

Reproductive planning Vs Menopause in CKD

None of the BRP members have leaked any clues about how they might vote on the Twitter just yet. Therefore, we decided to do a deep dive and search the #WorldkidneyDay chat. This gives us some important clues. Fiona Loud (@FionaCLoud), Policy Director at Kidney Care UK, who is a kidney transplant recipient herself, has talked about Pregnancy in CKD.

She has actively advocated for the patient’s perspective related to pregnancy in CKD during the World Kidney Day chat (#WKDChat).

So it will be not a surprise if she votes for ‘Reproductive Planning’. Also, Eleanor Lederer (@EleanorLederer) had actively participated in the #askASN Chat and discussed reproductive issues in CKD

And she surely advocates pregnancy in glomerular diseases.

Quotes by Roger Rodby (@NephRodby) on reproductive planning are so famous that he was quoted in a presentation in India.

After reading his paper on “Disease-specific patient reported outcome tools for SLE” we are confident that he will favor reproductive planning. A Twitter and PubMed search for Deidra Crews (@DrDeidraCrews) didn’t reveal any clue directly related to these regions, however she has done some commendable work in the field of disparities in Chronic kidney disease and transplant which makes me believe that she will support reproductive planning in CKD as well.

Thus 4/9 votes for reproductive planning.

None of the PubMed/Twitter accounts of other BRP members had any other clues however, this post by Mark Reid (@medicalaxioms) might be the best clue we can get and is “right” to the point.

Menopause in CKD is an equally important topic addressing harmful effects on cardiovascular risk, bone health and on patients’ quality of life. But we expect ‘reproductive planning’ to be much more popular amongst the BRP. Also, Selection committee member Michelle Hladunewich (@mhladunewich) will try to persuade the BRP in the favour of Reproductive Planning as is evident in her important review on pregnancy in CKD and recently in ESKD.

A battle for the larger Global Impact: Preeclampsia Vs Prematurity

Two of the BRP members Fiona Loud and Mark Reid have a shared their experience with Preeclampsia in these tweets.

Eleanor Lederer has elegantly explained urinary findings is preeclampsia in this paper and she has also addressed this issue on twitter.

Tazeen Jafar’s work on young prehypertensives, on hypertension and cardiovascular health,  and on coronary artery disease in women is likely to make her inclined towards preeclampsia.

This makes it again 4/9 votes for preeclampsia.

The only BRP member who may lean towards ‘Prematurity’ is  Sarah Faubel (@doc_faubel) by the virtue of her work AKI in neonates. Bryan Carmody (@jbcarmody) has made an excellent argument in favor of prematurity in AJKD blog mentioning the long-term kidney outcomes, but unfortunately, he is not on the Blue Ribbon Panel.

Preeclampsia seems to be very popular amongst those who have already filled their brackets.

And that’s my poll for the Women’s Health Region

Bottomline – Women’s health region is here to win. Choose your pick wisely.

Follow #NCWC for daily region updates.

Read the full AJKD blog (and check out the full scouting report for the #Women’s healthregion here).

Submit your NephMadness brackets here.

Do let us know about your choices in the comments.

#NephMadness Choosing Wisely Campaign (#NCWC) – Animal House Region (#AnimalRegion)

Blog Post

As the submission deadline for picks for #NephMadness 2018 approaches, many of us are wondering how the Blue Ribbon Panel will make its decisions on which teams should advance to the next round. Here we take a look at the Animal House Region (#AnimalRegion) to see who looks like an under-dog and who may come out top dog (animal puns are an added benefit of this region!)

The Battle of Osmolality Regulation: Pee Shark versus Salt-Switching Salmon

It’s tough to get a read from selection committee member Dr. Mark Zeidel and Dr. Timothy Yau’s (@Maximal_Change) great scouting report of this region. This opening battle serving as a clash of the competing osmololar balance mechanisms. Based on popular opinion alone, the shark appears to be somewhat of a fan favorite, judging by the interest garnered by a tweet thread appears in August 2017 about the Greenland shark. While not entirely composed of urine, sharks maintain extremely high urea levels to act as “osmoregulatory ballasts” allowing these predators to maintain osmolality in the range of 1,000mOsm/kg with 30% composed of urea. In addition to their fascinating physiology, sharks also possess fine control of osmoregulation through their rectal glands, with Na/K/2Cl concentrations 50x that of the TAL in humans. Additionally, this discovery has allowed for advances in our understanding of the TAL and diuretic physiology – findings with direct and important consequences for humans.


However, Team Salmon also puts together a convincing team, with a versatility not often matched in this year’s field. As a teleost fish, salmon adapt from freshwater to saltwater and back again to freshwater, a swing of environmental osmolality of 1,000 mOsm/kg without significant changes in serum osmolality. This is due to a combination of osmosensor mediated diffusion and upregulation of transporters in the gills, as well as specialized cells in the GI tract. If adaptability is the key to a team’s success, Salmon may be the sleeper in this region.

 Camel versus Toad: Water, water everywhere or nowhere?

This matchup is the battle of adaption to environmental extremes, and it’s tough to get a read from the selection committee scouting report. This dipsogenic dromedary is the exception rather than the rule with regard to osmolality. Returning to the scouting report, Dr. Zeidel focuses on the physiology of this adaptive response:

Despite these adaptive responses, as camels dehydrate over their 2 weeks without water, their Na rises from 154 to 191 mEq/L, with corresponding serum osmolality rising from 304 to 406 mOsm/kg. When given access to water, they re-hydrate rapidly; they lower their serum Na and osmolality to baseline levels within hours. And again, despite this massive shift, their mentation and neural function remains intact. Remarkably, these large swings in serum osmolality do not alter the camel’s neurological functioning.

Camels appear to be drawing strong support on Twitter, with memes in support of this team almost equaling that of Team Shark above. One weakness of the Camel team is the lack (so far at least!) of physiologic understanding of how camels tolerate such dramatic dehydration/rehydration – although some supporters of this team may argue that this makes the feet even more impressive!

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Team Toad’s argument is for the power of the amphibian’s bladder, with the ability to reabsorb water from the bladder as needed depending on evaporative skin losses. First discovered in the 1950s, this physiologically advanced animal (along with others) was responsible for the discovery of aquaporins and essential in our understanding of free water homeostasis. Findings of this advanced physiology in toads and frogs has had direct implications for our understanding of water handling in the human distal tubule. Additionally, the discovery of aquaporins was considered so fundamental that Peter Are won a Nobel Prize for this finding, further strenghting the importance of this team.

Can we gather any information about how the Blue Ribbon Panel will vote? A search of their twitter activity doesn’t reveal any strong preferences, retweets or suggestions of animal preference – in fact all members of the Blue Ribbon Panel have been silent on this region. A quick review of PubMed offers a few clues into how the panelists may vote. Sarah Faubel (@Doc_Faubel), for example, is interested in animal models of AKI, suggesting that she may pick a team from this region to go deep in this year’s tournament. Additionally, Eleanor Lederer (@EleanorLederer) studies regulation of sodium phosphate transporter in proximal renal tubule cells, suggesting that she may be on Team Shark.