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Introduction: Rituximab is the recent treatment of choice for primary membranous nephropathy However, dose of rituximab mentioned in literature is high and not economical in middle income countries. Low dose rituximab based on CD 19 cell count can be tried as an alternative for high dose rituximab for inducing clinical remission in appropriate clinical settings. Case Series: Four patients were administered low dose rituximab and initial CD 19 count was monitored for optimal rituximab response. Three males and one female are part of this case series. Renal biopsies showed membranous nephropathy with tissue phospholipase A2 receptor (PLA2R) positivity in two cases. Serum PLA2R was positive for the same two cases. Two patients completely remitted after one year, one male patient required additional rituximab dose based on CD19 count, one patient required single dose of rituximab for partial remission in the background of tacrolimus with steroids. One patient failed to remit on low dose rituximab protocol. Conclusion: Low dose Rituximab can be tried as a favorable alternative for high dose Rituximab in appropriate clinical settings.

Introduction: Clinical tools to predict acute kidney injury (AKI) in intensive care unit (ICU) are lacking. Objectives: This prospective study was conducted to assess the utility of furosemide stress test (FST) to predict AKI and its progression to severe stages and requirement of hemodialysis (HD). Patients and methods: Patients in AKI stage I or II were given a standardized dose of frusemide as per protocol. The study cohort included 62 patients. Response to FST was assessed by urine output (UOP) at 2 hours. Study patients were subsequently divided into two groups, those with UOP >200 mL (group A) and those with UOP <200 mL (group B). Results: Group A constituted 71% (n=44) of cases. Of them, 2 (4.54%) patients progressed to AKI Network (AKIN) stage III. Group B constituted 29% of cases (n=18). Of them, 12 (66%) cases progressed to AKIN stage III. In group A, 4.5% (n=2) of cases required HD. In comparison, 55% (n=10) of group B patients required HD during the hospital stay. Mortality rate was 6.8% (n=3) in group A and 33.3% (n=6) in group B. The duration of stay was more in the patients with UOP <200 mL group compared to UOP >200 mL group. Conclusion: FST may be a reliable predictor of AKI progression to severe stages and requirement of dialysis in ICUs.

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