In the AKI bracket one team caught my eye, RIPC, Remote Ischemic Preconditioning. This is a procedure of inducing transient ischemia in the arm by inflating a BP cuff for 5 minutes x2 with an interim deflation for 5 minutes. This procedure was done before coronary angiography, aneurysm repair and was shown to reduce myocardial ischemia, renal injury and contrast-induced nephropathy. These procedures have a high prevalence and there are no other therapies to reduce CNI other than fluids (see ACT trial on N-acetyl cysteine), this team is a good contender this year. Hopefully we will see more evidence for this simple procedure. However, my favorite from this group is normal saline, simple, cheap effective, global! How many times has an acute renal failure case, presented to you as a complicated mess by a resident, been solved by some salty water!! I love it! This team goes all the way to the final four for me.
Remember to fill out your NephMadness 2014 brackets! Find them at eAJKD