Background: Isolated or predominant tubulointerstitial lupus nephritis is rare. Case Presentation: Here we report the case of a thirty eight years old male who was diagnosed with systemic lupus erythematosus (SLE) according to clinical and laboratory criteria and presented with impaired renal function and non nephrotic range proteinuria. Renal biopsy revealed normal glomeruli but interstitial momonuclear cell infiltration. Immunohiostochemistry (IHC) showed immune deposits in the tubular basement membranes (TBMs), and the peritubular capillary basement membranes (PTCBMs). He was started on high dose oral steroids, which were gradually tapered over one month. His renal functions improved over few days and normalized by the end of the first month of treatment. He was continued on low dose steroids and azathioprine with no evidence of relapse. Conclusions: Predominant tubulointerstitial lupus can occur, although rarely; and it runs a favorable course with good response to treatment. Case ReportImplication for health policy/practice/research/medical education: Renal tubulointerstitium can be involved in all classes of lupus nephritis but predominant tubulointerstitial lupus without evidence of glomerular lesion is rare. In this study we described a pure tubulointerstitial lupus nephritis.Please cite this paper as: Ali A, Al-Windawi S. Tubulointerstitial Lupus nephritis. J Nephropathology. 2013; 2(1): 75-80.

Renal transplantation is the treatment of choice for patients with end-stage renal disease. In Iraq, renal transplantation started in 1973 and has continued until now with live donor transplantation, since deceased donor transplant program is not approved as yet. Long-term transplant data are still scarce. The aim of our study is to present data on transplantation and medical follow-up at one year and, survival analysis at one, three and five years. A total of 250 renal transplantations were performed at the Nephrology and Renal Transplantation Center, Baghdad between January 2009 and January 2014. It is a living donor, blood group compatible donor program. All patients received triple immunosuppression (calcineurine inhibitor, mycophenolate mofetil or mycophenolic acid, and steroid). The Kaplan-Meier method was used to determine the survival rate. There were 92 live related donors, 143 unrelated donors, and 15 spouse donors. The mean age was 34.07 ± 12.2 years. The one-year graft survival for related and unrelated donor transplants was 98.9% and 91.8%, respectively. Graft survival was lower (82.9%) in recipients with acute rejection episodes. The patient survival at one-year was 94%. The three-year graft and patient survival was 91% and 90%, respectively, and five-year survival for grafts and patients was 87.1% and 88%, respectively. The outcome of the renal transplantation in Iraq is improving. Long-term patient follow-up needs more meticulous attention. The development of renal transplant registry is critical for future planning. Moreover, renal transplantation practice in Iraq needs more social, religious, and governmental support.

To determine the safety and efficacy of the practice of renal allograft biopsy and verify its impact on the management of kidney transplant patients presenting with graft dysfunction, we studied 50 renal allograft biopsies of 47 adult patients (38% males, mean age 32.4 ± 11 years) performed in the medical city complex from November 2008 to April 2011. All the biopsies were performed with a guidance of ultrasound. The procedure, complications, histological diagnoses and impact of the biopsy data on patients' management were recorded. Thirty percent of the biopsies were performed in the first 12 months post-transplantation and 24% were performed after the 60 th month. Adequate biopsy was achieved in 76% of the patients, with a 96% safety rate. Acute rejection was diagnosed in 38% of the biopsies and chronic allograft nephropathy in 38%, and they were the most common histological patterns in the study. The results of allograft biopsies positively impacted the management strategy in all study groups. Renal allograft biopsy was a useful and a relatively safe tool for the diagnosis of acute and chronic graft dysfunction in our experience.

Background: Volume overload is common in end stage kidney disease (ESKD) and dialysis patients. Hence, the need for objective tools to detect such volume excess. Point of care ultrasound (POCUS) is a goal-directed, bedside examination to answer such a specific diagnostic question. Methods: One hundred Iraqi adult hemodialysis patients were recruited from February 1 to May 31, 2022. Primary clinical, dialysis data, and prescriptions were recorded. A nephrologist performed a POCUS examination after the last dialysis session of the week. In addition, an ultrasound examination of the chest was performed to detect B-lines and pleural effusion. Caval parameters included inferior vena cava (IVC) diameter and collapsibility index.  Results: The mean age of the study group was 51.48 ± 14.6 years, with 53% males. The mean interdialytic weight gain was 2.74 ± 1.15 Kg. Lower limb edema and pleural effusion were present in 33% and 27%, respectively. Forty-seven percent of patients had >3 B-lines on lung ultrasound with a range of 12. Forty-three percent of patients had an IVC diameter of >2 cm, and 93% had <50% IVC collapsibility. In total, 97% of patients had evidence of excess volume by ultrasound criteria. IVC collapsibility index was the most prevalent sign of excess volume (93%). Patients without lower limb edema and pleural effusion had positive B-lines in 38.8% and 38.3%, an IVC diameter >2 cm in 46.2% and 38.3%, and IVC collapsibility <50% in 89.5% and 95.8% respectively.  Conclusion: Iraqi maintenance hemodialysis patients are volume overloaded, which warrants proper intervention for detection and dialysis management. POCUS is a useful and easily performed technique to assess the volume status.

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