Clinical and Immune Aspects of Idiopathic Acute Tubulointerstitial Nephritis and Uveitis Syndrome

Abstract

Five patients with idiopathic interstitial nephritis and uveitis without bone marrow granulomas were followed-up for 1 year. Ophthalmological examination revealed bilateral anterior uveitis. Light microscopy of the renal tissue revealed predominant lymphocyte infiltration of the interstitium. Immunohistochemical analysis revealed a clear predominance of memory T lymphocytes (CD45RO+) in the interstitial and tubular infiltration. HLA typing, and immunophenotypic studies of peripheral blood mononuclear cells including absolute lymphocyte and monocyte counts were assessed. The patients’ peripheral T-cell subpopulation did not significantly differ from control studies. With steroid treatment maintained during a period of 6-9 months renal function and uveitis responded dramatically in all patients. After 1-year follow-up, only 1 patient showed a relapse of uveitis, but there was complete clinical recovery of the nephritis in all 5 patients. The aim of this study was to describe the 1-year follow-up of 5 new cases of acute tubulointerstitial nephritis and uveitis syndrome, and assess some aspects of their cellular immunity.

TINU Syndrome Associated with Reduced Complement Levels

“…It is therefore possible that during specific moments of the acute phase, both a cell-mediated immune response and a humoral response intervene to evoke a TINU syndrome. The inflammatory nature of the pathology appears to be confirmed by the excellent results obtained with steroid therapy and the significant postinflammatory improvement of the clinical and immunological parameters [2, 3, 4, 5, 6, 7]. …”

Management of uveitis: A rheumatologic perspective

“…Although TINU was first described in 1975 (18), it was not until the last decade that sufficient numbers of patients had been described in the literature to clarify the clinical features of this syndrome (19)(20)(21). Pathogenic mechanisms remain unclear, although the renal biopsy generally shows a lymphocytic infiltrate of the interstitium along with tubular atrophy (19).…”

“…Pathogenic mechanisms remain unclear, although the renal biopsy generally shows a lymphocytic infiltrate of the interstitium along with tubular atrophy (19). Immunofluorescence studies have yielded negative results (19). The typical patient is an adolescent female.…”

Pseudotumor cerebri following cyclosporine A treatment in a boy with tubulointerstitial nephritis associated with uveitis

“…TINU syndrome occurs mainly in females and is very rare in males [2]. The uveitis may precede, occur with, or follow the nephropathy [3]. If the patient shows dramatic improvement in renal function on therapy with prednisone, the clinical course is favorable.…”

“…If the patient shows dramatic improvement in renal function on therapy with prednisone, the clinical course is favorable. Nephropathy and uveitis normally show complete recovery, but uveitis may remain chronic [3]. The etiology and pathogenetic mechanisms of tubulointerstitial nephritis are unknown.…”