RE: CD19, ritux, and membranous 1 hour 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 2 hours 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 3 hours 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 3 hours 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 5 hours 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 17 hours 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 19 hours 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 19 hours ago

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

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RE: Persistant metabolic acidosis after cystectomy 19 hours 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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? 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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? 1 day 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? 1 day 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 1 day ago

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

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RE: is it lead poisoning? 1 day 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 1 day 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? 1 day 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? 1 day 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? 1 day 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? 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 days 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 2 days 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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