RE: Painless macroscopic hematuria 13 minutes ago

If other more likely causes for painless gross hematuria are excluded then even if NCS is diagnosed but no anemia or symptomatic varicocele , treat...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 1 hour ago

Makes sense - could also do retrograde study rt kidney and stent if obstructed , biopsy left kidney after CT. I would still recommend KUB to help e...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 2 hours ago

A CT can be done with sedation, but most frequently we do them under general anesthesia. The radiologists at my hospital certainly prefer GA when c...

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RE: CD19, ritux, and membranous 3 hours ago

@Christian Kuhn Regrettably the DOI of the reference you posted appears to be incorrect. Could you please either revise it or attach the actual P...

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RE: Painless macroscopic hematuria 3 hours ago

Painless gross hematuria for 2+ years- Nutcracker Syndrome unlikely but probably should be exclude with appropriate imaging studies if hemoglobin e...

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RE: Painless macroscopic hematuria 3 hours ago

Although IgAN is most common disease in this age group, i would like to rule out other causes like Alport syndrome or Thin basement disease . On ...

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RE: CD19, ritux, and membranous 10 hours ago

@Hormaz Dastoor II completely agree that CD20 internalization is primarily an issue with rituximab and occurs to a much lesser extent with obinutuz...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 12 hours ago

Does a CT in a dog require general anesthesia? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medic...

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RE: Persistant metabolic acidosis after cystectomy 17 hours ago

Today only I reviewed the case presentation and hence delayed response I pulled out lot of information from resources Please pardon me for the le...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 18 hours ago

What would NSAIDs be responsible here? Would love the veterinarians on this post to explain how this canine could possibly have normal renal functi...

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RE: CD19, ritux, and membranous 20 hours ago

I think the "bottom line" is that we are still learning how to interpret CD19/20 B cell monitoring in peripheral blood in patients receiving anti-C...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 20 hours ago

Hi Eva! Very weird left kidney for sure! I am worried the RK is obstructed from the nephrolith(s), potentially pyonephrosis. I'd be worried ab...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 20 hours ago

It looks like this dog is headed for surgery to obtain a definite diagnosis-, nematodes, cancer, or nephrolithiasis or some combination of these.. ...

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RE: CD19, ritux, and membranous 20 hours ago

@Christian Kuhn correct me if I am wrong but CD20 internalization is something specific to Rituximab only and not Second generation Anti CD20 agent...

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RE: CD19, ritux, and membranous 1 day ago

Dr. Kuhn- I agree that many long-lived Plasma Cells secreting potentially pathogenic auto-antibodies (CD19+ and CD20 - ) are not depleted by RTX ...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 1 day ago

Thanks for sharing -US iMO shows different process in left and rt kidney. The hematuria could be resulting from both but different pathologies. Nep...

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RE: Persistant metabolic acidosis after cystectomy 1 day ago

Thanks! My question is whether a bicarbonate of 20 mmol/L on Nephrotrans alone justifies surgical revision. The KDIGO 2024 CKD guideline gives [M...

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RE: CD19, ritux, and membranous 1 day ago

"CD20 + : expressed only on B cells and not on plasma cells . hence when anti CD20 agents such as rituximab are used , they deplete B cells directl...

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RE: Dog with hematuria and highly unusual renal ultrasonographic findings 1 day ago

Copied and pasted your post on Google AI. It responded as follows: "The left kidney findings are highly concerning for a Renal Pelvic Diverticulu...

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Dog with hematuria and highly unusual renal ultrasonographic findings 1 day ago

Hello! I'm hoping for ideas on what we're seeing on ultrasound in a canine patient. The dog is an 8-year-old female spayed Cocker Spaniel who prese...

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RE: CD19, ritux, and membranous 1 day ago

I think, as you pointed out, that the interaction between Ritux and anti-complement agents is, for now, hypothetical. Aside from the occasional use...

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RE: CD19, ritux, and membranous 1 day ago

Thank you ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Persistant metabolic acidosis after cystectomy 1 day ago

I asked copilot what is the optimal length for ileal conduit. It came back with 20 cm. I think the urine pH confirms that the transit time is too l...

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RE: C3GN with lambda light chains 2 days 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 2 days 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 days 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 2 days 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 2 days 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 2 days ago

Dr. Dastoor - thanks for this nice summary. I have a few minor corrections Free lambda LC often spontaneously form dimers by covalent linkage ...

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RE: C3GN with lambda light chains 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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? 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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? 2 days 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? 2 days 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 2 days ago

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

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RE: is it lead poisoning? 2 days 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 2 days 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? 2 days 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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