Long-term outcome of biopsy-proven idiopathic tubulointersitial nephritis with or without uveitis in children—a nationwide follow-up study

Abstract

Background Only a few studies reporting the long-term outcome of children with idiopathic tubulointerstitial nephritis (TIN) and uveitis syndrome (TINU) are available. We studied the long-term kidney and ocular outcome in a nationwide cohort of children with TIN or TINU. Methods All patients followed up for a minimum of 1 year by a paediatrician and an ophthalmologist were enrolled. The data on plasma creatinine (P-Cr), estimated glomerular filtration rate (eGFR), proteinuria, hypertension and uveitis were collected retrospectively. Results Fifty-two patients were studied. Median age at time of diagnosis was 13.1 (1.8–16.9) years and median follow-up time was 5.7 (1.1–21.2) years. Forty-five (87%) patients were initially treated with glucocorticoids. The median of the maximum P-Cr was 162 μmol/l (47–1,016) and that of eGFR 47 ml/min/1.73m2 (8–124). Uveitis was diagnosed in 33 patients (63%) and 21 (40%) patients developed chronic uveitis. P-Cr normalised in a median of 2 months. Eleven (21%) patients had nephritis recurrence during or after discontinuation of glucocorticoids. At the latest follow-up, 13 (25%) patients had eGFR < 90 ml/min/1.73m2 (median 83; 61–89 ml/min/1.73m2). Six patients had tubular proteinuria; all presented with TIN without uveitis. Seven (13%) patients were hypertensive. Eleven (21%) patients had uveitis. One patient developed uraemia and was later transplanted. Conclusions Our study questions the previously reported good long-term kidney and ocular outcome of patients with TIN/TINU. Decreased kidney function and/or ocular co-morbidities may persist for several years; thus, both kidney and ocular follow-up for at least 1 year is warranted. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Renal Prognosis in Children With Tubulointerstitial Nephritis and Uveitis Syndrome

“…). 23 This could be explained by a delayed diagnosis leading to a late-onset treatment. At last, our criteria for a total renal recovery based on the guidelines of Kidney Disease: Improving Global Outcomes for the evaluation of chronic kidney disease are more stringent than those from other studies in which an eGFR >70 ml/min per 1.73 m 2 was considered as a total recovery.…”

Acute Interstitial Nephritis in the Pediatric Population: A Review of Etiologic Associations, Histologic Findings, and Clinical Outcome

“…Most patient's with TINU recover kidney function. 17 In conclusion, pediatric AIN differs from AIN seen in the adult population with significantly more cases of TINU and fewer cases of drug induced interstitial nephritis. Although the inflammatory cell composition is not specific, it can provide clues about the etiology.…”

TINU syndrome - literature review

“…Objawy oczne również nie są szczególnie charakterystyczne i nie zawsze występują w tym samy czasie co symptomy związane z nerkami. Do głównych objawów związanych ze wzrokiem zalicza się ból, zaczerwienie oczu, światłowstręt oraz pogorszenie widzenia [27][28][29]. W badaniu okulistycznym zazwyczaj stwierdza się nieziarniniakowe zapalenie przedniego odcinka błony naczyniowej oka, [30] ale liczne doniesienia wskazują, że objawy mogą obejmować zdecydowanie szersze spektrum takie jak: izolowany obrzęk plamki, odbarwione blizny naczyniówkowo-siatkówkowe, obecność komórek w ciele szklistym [31].…”