Enhanced Recognition, Treatment, and Prognosis of Tubulointerstitial Nephritis and Uveitis Syndrome

Mackensen, Friederike; Smith, Justine R.; Rosenbaum, James T.

doi:10.1016/j.ophtha.2007.01.002

Cited by 133 publications

(134 citation statements)

References 14 publications

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“…Furthermore, in 26% of our cohort, symptoms of uveitis were subtle and subclinical, which is similar to a recent prospective study in children with TINU (25). On the other hand, ophthalmologists have reported that up to 1%-2% of patients with uveitis have tubulointerstitial nephritis (26)(27)(28), which itself could be an underestimation because patients with TINU may have exhibited tubular dysfunction with normal SCr levels. Together with our findings, these data suggest that TINU syndrome is significantly underdiagnosed.…”

Section: Discussionsupporting

confidence: 88%

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Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Chu

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Tubulointerstitial nephritis and uveitis (TINU) syndrome is considered a rare cause of acute tubulointerstitial nephritis (ATIN) that is usually associated with renal recovery. This study sought to investigate the diagnosis, prognosis, and contributing factors of TINU syndrome using a large cohort of patients with prospective follow-up.Design, setting, participants, & measurements This study included patients with TINU syndrome from a prospective cohort of patients with ATIN from 2007 to 2012. Clinical-pathologic data were collected at biopsy and autoantibodies against modified C-reactive protein (mCRP-Ab) were measured. Serum levels and renal tissue expression of Kreb von den Lunge-6 were also detected. Independent risk factors for poor renal outcome at 12 months and late-onset uveitis were analyzed.Results Thirty-one patients (28%) with biopsy-proven ATIN were classified as having TINU syndrome. Of these patients, 18 (58%) developed late-onset uveitis and were misdiagnosed as having drug-induced ATIN at the time of biopsy. An abnormal level of mCRP-Ab was an independent risk factor for late-onset uveitis (odds ratio, 14.7; 95% confidence interval, 3.4 to 64.0). Patients with TINU syndrome and drug-induced ATIN had comparable levels of Kreb von den Lunge-6 in both serum and renal tissues. Ninety-two percent of patients developed stage 3-4 CKD and/or tubular dysfunction by 12 months postbiopsy. Age, serum creatine level, erythrocyte sedimentation rate, and the presence of concomitant thyroid disease or leukocyturia were related to poor renal outcome. Relapse was seen in 36% (11 of 31) of patients and potentiated poor renal outcome. ConclusionsThe diagnosis of TINU syndrome can be missed in a large fraction of patients with ATIN because uveitis can present well after the onset of tubulointerstitial nephritis. Elevated mCRP-Ab levels may be useful in predicting late-onset uveitis TINU syndrome. Unfortunately, patients with TINU tended to have frequent relapses and most patients had incomplete renal recovery. Long-term follow-up is needed to prevent misdiagnosis and properly manage TINU syndrome.

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Section: Discussionsupporting

confidence: 88%

“…In contrast, most reports thus far have suggested a good outcome (4-16), with only a few studies claiming prolonged renal insufficiency after TINU (2,27,33,34). This discrepancy might be due to three factors.…”

Section: Discussionmentioning

confidence: 93%

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Chu

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…2 It presents as episodes of sudden onset of bilateral anterior non-granulomatous uveitis, and it is chronic or recurrent in about one-half of reported individuals. 1,10 We present a case of a patient with relapsing polychondritis and TINU syndrome. To our knowledge, this is the first case of TINU syndrome associated with relapsing polychondritis to be reported.…”

Section: Introductionmentioning

confidence: 99%

Tubulointerstitial Nephritis and Uveitis Syndrome: Case Report and Review of the Literature

Aguilar¹,

Lonngi²,

de-la-Torre

2015

Ocular Immunology and Inflammation

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Purpose:To review the literature on tubulointerstitial nephritis and uveitis (TINU) syndrome, and to report a case of a patient with relapsing polychondritis (RP) and TINU syndrome. Method: TINU syndrome is a rare oculo-renal inflammatory disorder. It is more common in young women with autoimmune conditions, infections, systemic disease, and previous use of medications. We report the case of a 62-year-old woman with relapsing polychondritis and a 2-year history of acute, recurrent, asymmetric, bilateral, anterior, nongranulomatous uveitis accompanied by tubulointerstital nephritis. The patient was diagnosed with TINU syndrome associated with relapsing polychondritis. No cases of this association have been reported in the literature. The clinical features of TINU syndrome are discussed based on the published works. Conclusion: TINU is an uncommon syndrome; only about 200 cases have been reported in the literature related to infections, systemic disease, and previous use of medications such as antibiotics and non-steroidal anti-inflammatory drugs. We found that it can be associated with relapsing polychondritis; therefore, it is important to investigate symptoms of this disease since TINU syndrome can co-exist with it.

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“…TINU syndrome is characterized by tubulointerstitial nephritis with bilateral sudden-onset anterior uveitis (1). Since the first description in 1975 by Dobrin et al (2), over 200 cases have been described in the literature with a median age of onset at 15 years (range 9 to 74 years) and a 3:1 female-to-male predominance (3).…”

Section: Introductionmentioning

confidence: 99%

Modified C-Reactive Protein Might be a Target Autoantigen of TINU Syndrome

Tan

et al. 2011

Clinical Journal of the American Society of Nephrology

101

103

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SummaryBackground and objectives The cross-reactive antigen(s) of tubulointerstitial nephritis and uveitis (TINU) syndrome from renal tubulointerstitia and ocular tissue remain unidentified. The authors' recent study demonstrated that the presence of serum IgG autoantibodies against modified C-reactive protein (mCRP) was closely associated with the intensity of tubulointerstitial lesions in lupus nephritis. The study presented here investigates the possible role of IgG autoantibodies against mCRP in patients with TINU syndrome.Design, setting, participants, & measurements mCRP autoantibodies were screened by ELISA with purified human C-reactive protein in 9 patients with TINU syndrome, 11 with drug-associated acute interstitial nephritis, 20 with IgA nephropathy, 19 with minimal change disease, 20 with ANCA-associated vasculitis, 6 with Sjogren's syndrome, and 12 with amyloidosis. mCRP expression was analyzed by immunohistochemistry in renal biopsy specimens from the 9 patients with TINU syndrome and 40 from disease controls. Frozen normal human kidney and iris were used to demonstrate co-localization of human IgG and mCRP from patients with TINU syndrome with laser scanning confocal microscopy. ResultsThe mCRP autoantibodies were detected in all nine patients with TINU syndrome, significantly higher than that of those with disease controls (P Ͻ 0.05). The renal histologic score of mCRP in TINU syndrome was significantly higher than that in disease controls (P Ͻ 0.05). The staining of mCRP and human IgG were co-localized in renal and ocular tissues. ConclusionsIt is concluded that mCRP might be a target autoantigen in TINU syndrome.

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Enhanced Recognition, Treatment, and Prognosis of Tubulointerstitial Nephritis and Uveitis Syndrome

Cited by 133 publications

References 14 publications

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Tubulointerstitial Nephritis and Uveitis Syndrome: Case Report and Review of the Literature

Modified C-Reactive Protein Might be a Target Autoantigen of TINU Syndrome

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