RE: C3GN with lambda light chains 42 minutes ago

@Richard Glassock thank you for that summary on K and Lamda chains . i was completely unaware of these succinct points highlighted . ------------...

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RE: CD19, ritux, and membranous 51 minutes ago

Here is the link to the pictographs https://kdigo.org/wp-content/uploads/2026/06/KDIGO-2026-B-Cell-Conference-Report.pdf ---------------...

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RE: CD19, ritux, and membranous 2 hours ago

Dr. Rubin- Great point about the potential for an interaction between RTX and C inhibitors. This combination is seldom used ( except maybe in ANCA ...

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RE: CD19, ritux, and membranous 3 hours ago

@Hormaz Dastoor Great and succinct review of the key immunological issues involved. One important aspect to also consider is that Ritux requires ...

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RE: Painless macroscopic hematuria 3 hours ago

Thank you all for your suggestions and sharing your experience. I have requested a copy of the cysto report, I was going by the 'normal cysto' t...

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RE: C3GN with lambda light chains 6 hours ago

Dr. Dastoor - thanks for this nice summary. I have a few minor corrections Free lambda LC often spontaneous ly for diners by covalent linkage ...

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RE: C3GN with lambda light chains 8 hours ago

Light chains ( usually lamda) can activate either the Classic Pathway or the Alternate Pathway (AP) Within the realm of Alternate Pathway : Lamd...

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RE: CD19, ritux, and membranous 10 hours ago

Yes, but this effect is seen mainly in lymphoid germinal centers, not in peripheral blood B cell pools. ------------------------------ Richard Gl...

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RE: CD19, ritux, and membranous 11 hours ago

Thanks so much Does obi deplete plasma blast more than rituxan ? --------------------------------- Muhammad Soobadar MBChB UK -----------------...

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RE: CD19, ritux, and membranous 13 hours ago

CD19+ : expressed on B cells , Plasmablasts, Short lived Plasma cells ( CD19 +) and not expressed on Long Lived Plasma cells which are located in B...

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RE: Resistant hypertension 14 hours ago

The drug has been approved in the UAE for uncontrolled HTN or resistant hypertension ( defined as 3 or more drugs). Hence these patients need not b...

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RE: CD19, ritux, and membranous 14 hours ago

Dr. Hirsch-thsnks for the question. RTX is quite effective in depleting CD19/20+ B cells from peripheral blood but it is much less effective for de...

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RE: To RITUX or NOT RITUX 14 hours ago

We had an MDT meeting with rheumatologist and GI team yesterday. We agreed to prophylactic Rituximab given his high risk and stop Avacopan. He seem...

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RE: is it lead poisoning? 14 hours ago

Here is a nice review of CKD due to lead intoxication (Rastogi SK. Ind J Occup Environ Med 2008; 12:103. The proteinuria in Lead Intoxication is ty...

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RE: CD19, ritux, and membranous 15 hours ago

Thanks you folks. I am wondering: If Rituximab fully depletes the CD19 B cells but still does not yield a clinical response, what would be the me...

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RE: Treatment /Management of MN 15 hours ago

I completely agree with Dr. Caster. The era of trials of novel therapies for MN using CNI (plus steroids) as the compactor arm is over. Anti-CD-20 ...

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RE: CD19, ritux, and membranous 17 hours ago

I think it would be reasonable to try obi in this setting. I have had patients respond to it that did not respond to rituximab regardless of CD19 l...

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RE: Treatment /Management of MN 17 hours ago

I completely agree that the combination of anti-CD20 with CNI compared with anti-CD20 alone should be evaluated in an RCT. As mentioned before, ...

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RE: CD19, ritux, and membranous 18 hours ago

I look forward to Dr. Caster's response, but in my opinion thuis is exactly the indication for OBI first, and maybe CYC + RTX as a second choice. ...

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RE: Treatment /Management of MN 18 hours ago

I have virtually no experience with use of combined RTX + CNI in MN. Is there any published experience that demonstrates superiority of this combin...

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RE: CD19, ritux, and membranous 18 hours ago

Thanks prof caster. Have you encountered a case where cd19 depleted with ritux but plar2 not going down after 4-6 month Do you go For Obi assume ...

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RE: is it lead poisoning? 18 hours ago

Isolated glomerular proteinurua can certainly be seen in IgA N, butvwoykd be uncommon in Active Vasculitis and anti-GBM disease, myeloma cast Nephr...

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RE: is it lead poisoning? 18 hours ago

Ratio urine acr/pcr 0.62 Urine pcr 313.8 mg/mmol --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Treatment /Management of MN 18 hours ago

Thanks prof glassock for your invaluable input 💪🏼💪🏼💪🏼 --------------------------------- Muhammad Soobadar MBChB UK ------------------------...

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RE: is it lead poisoning? 18 hours ago

Thanks prof glassock Can I ask in general if one has Proteinuria and no haematuria it can still be Iga /myeloma but it would not be like active Va...

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RE: Treatment /Management of MN 18 hours ago

It is the steroids that cause increased infection risk, not much signal of increased infection risk with RTX monotherapy in MN. See the MENTOR tria...

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RE: is it lead poisoning? 18 hours ago

I doubt that this degree of hypertension would be the cause of his proteinuric CKD. What is his current eGFR and changes over last 2-3 years. 3+ by...

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RE: is it lead poisoning? 19 hours ago

Also when I saw him in clinic urine dipstick was negative for blood --------------------------------- Muhammad Soobadar MBChB UK --------------...

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RE: is it lead poisoning? 19 hours ago

i booked him for biopsy and consultant colleague emailed me today to say he is HTN and whether this all due to HTN and whether i want to proceed wi...

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is it lead poisoning? 19 hours ago

74 m relatively preserved kf but seems bp has been high since Dec 25 . gout dx 1990 New proteinuria since August 25 August 25 normal Dec 25 17...

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RE: Treatment /Management of MN 21 hours ago

@ prof caster really helpful for tac input I have reduced steroids today to 20 mg and next time will go down to 10 mg also reduced diuretics as he...

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RE: Treatment /Management of MN 21 hours ago

Thanks you prof caster prog glassock / prof rodby Question In elderly patient is there an increased signal for infection when using ritux in elde...

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RE: To RITUX or NOT RITUX 21 hours ago

i would treat too only issue is does rituxan cause his UC to flare? and how would you get him to agree? just curious any microscopic haematur...

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RE: Resistant hypertension 21 hours ago

Aside from stopping minoxidil I note that the difference in BP meds, between the first and last post, is the addition of chlorthalidone with the BP...

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RE: To RITUX or NOT RITUX 22 hours ago

With a rising anti-PR3-level and this history I would give serious consideration to restoring RTX prophylactically. Although the urine, ESR and CRP...

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RE: Resistant hypertension 22 hours ago

Dr. Dastoor. I am very curious concerning the efficacy of Aldostetone Synthetase inhibitors. These agents haves not yet been compared to Spironolac...

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RE: Resistant hypertension 22 hours ago

Before moving to denervation, kidney biopsy or Aldosterone synthetase inhibitors, I woukd make a serious effort to determine the contribution of no...

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RE: Resistant hypertension 23 hours ago

We have been using Aldosterone Synthase Inhibitor - Bardoxostat - for last few weeks - for uncontrolled or resistant HTN , with great results . M...

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To RITUX or NOT RITUX 23 hours ago

23-year old male patient, with the following: - Wegner's granulomatosis with polyangiitis (diagnosed in 2013 has had at least 3 doses of Rituxim...

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RE: CD19, ritux, and membranous 23 hours ago

I measure if the treatment response is not following the expected trajectory (PLA2R ab not falling). CD19 should be undetectable after giving ritux...

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RE: Painless macroscopic hematuria 1 day ago

Agree with Dr. Venkat-although I have never seen a case of gross hematuria due to hypercalciuria alone , it's apparently much more common in childr...

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RE: to do kidney biopsy or not 1 day ago

Since the patient's albuminuria is improving and if eGFR stable, given an increase risk of a kidney biopsy in a patient with advanced CKD and small...

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RE: Treatment /Management of MN 1 day ago

I completely agree with Drs. Glassock and Rodby that CNI + steroids would not be a first choice. 40 mg of prednisone for 8 weeks is a very high dos...

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RE: to do kidney biopsy or not 1 day ago

Lead and kidney disease: a chronic tubulointerstitial disease associated with HTN, I haven't seen a case in 40 years and I have looked for it , but...

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RE: Resistant hypertension 1 day ago

I like this regimen; AMLODIPINE 10 mg OD CCB TELMISARTAN 80 mg OD ARB MOXONIDINE 0.3 mg TID I had to look this one up but it seems like cloni...

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RE: Resistant hypertension 1 day ago

BP control improved in hospital. This suggests possible medication non-adherence as outpatient. Proteinuria is now minimal with 30-35 RBCs/HPF (p...

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RE: to do kidney biopsy or not 1 day ago

This patient's initial urine albumin/creatinine ratio was > 3.1g/g. There was decrease in UAlb/Cr ratio with losartan. Thus, there is significant g...

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RE: to do kidney biopsy or not 1 day ago

i think I remember 1case decadea ago. It is a rare condition nowadays, but it is so treatable and easy to diagnose with simple trsting that I would...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Neurological improvement may be due to reduction in brain edema/swelling after steroids. I am sure close clinical and imaging follow-up for the bra...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Now that CNS better - can discuss management of chronic allograft failure-if decision to not resume Belatacept ( why was it used instead of CNI in ...

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