TINU Syndrome Associated with Reduced Complement Levels

Conz, P; Milan, Massimo; Bragantini, L; Greca, G. La; Bevilacqua, P.

doi:10.1159/000046096

Cited by 10 publications

(5 citation statements)

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“…In patients with TINU, cells infiltrating to the renal interstitium were positive for the presence of the CD3 markers (CD4 > CD8) by immunohistochemical studies. [9][10][11] In the present patient, renal interstitial infiltrating cells were mainly CD4+ T lymphocytes, as seen in previous studies. These findings suggest that cellular immunity, mainly of helper T lymphocytes, may play a role in the pathogenesis of TINU.…”

Section: Discussionsupporting

confidence: 86%

Tubulointerstitial nephritis and uveitis syndrome associated with hyperthyroidism

et al. 2006

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We report a 17-year-old male patient with tubulointerstitial nephritis and uveitis (TINU) associated with hyperthyroidism. He presented with a 2-month history of fatigue, loss of appetite, low-grade fever, and a 12-kg weight loss when he was admitted to our hospital. He had iritis, which was complicated by fibrin in the anterior chamber, diagnosed by slit-lamp examination. On laboratory examinations, deteriorated renal function (blood urea nitrogen level was 25.9 mg/dl and creatinine level was 2.82 mg/dl) and elevated urinary levels of N-acetyl-beta-D-glucosaminidase (33.1 U/l) and beta2-microglobulin (78,600 microg/l) were observed. Serum thyroid-stimulating hormone (TSH) was undetectable, at less than 0.01 microIU/ml, and free triiodothyronine and free thyroxine were elevated, up to 5.23 pg/ml and 2.85 ng/dl, respectively. The titers of antithyroglobulin and antithyroid microsomal and TSH-receptor antibodies were not elevated. Abdominal and thyroidal ultrasonography showed evident bilateral enlargement of the kidneys and diffuse enlargement of the thyroid gland. Iodine-123 scintigraphy showed low uptake in the thyroid gland. The biopsied renal specimen showed mild edema and severe diffuse infiltration of mononuclear cells and few eosinophils in the interstitium, without any glomerular or vascular abnormalities. Based on the clinical features and pathological findings, a diagnosis of TINU syndrome with associated hyperthyroidism was made. Treatment was started with 30 mg/day of prednisolone. The iritis disappeared, and the patient's clinical status improved remarkably. This case suggests the possibility of thyroid dysfunction in some patients with TINU syndrome, and we believe thyroid function should be measured in all TINU patients. Moreover, histopathological diagnosis of the thyroid glands before treatment is necessary for TINU patients with thyroid dysfunction.

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Section: Discussionsupporting

confidence: 86%

Tubulointerstitial nephritis and uveitis syndrome associated with hyperthyroidism

et al. 2006

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“…1996), ANA, an autoantibody directed against renal tubular cells (Wakaki et al. 2001), RF and hypocomplementaemia (Conz et al. 2001) have been reported.…”

Section: Discussionmentioning

confidence: 99%

Tubulointerstitial nephritis and uveitis (TINU) syndrome: a case report and review of the literature

Thomassen

Ring

Thaarup

et al. 2009

Acta Ophthalmologica

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ABSTRACT.Purpose: We aim to describe the first case of tubulointerstitial nephritis and uveitis (TINU) syndrome reported in Scandinavia and to underline the importance of the syndrome, which should be better known among ophthalmologists. Methods: We report an 11-year-old boy who was admitted to hospital because of general fatigue and weight loss. Blood tests showed renal insufficiency and a renal biopsy revealed acute tubulointerstitial nephritis. One week after admission the patient developed transitory blurred vision and flickering shadows in the left eye. Slit-lamp examination revealed bilateral anterior non-granulomatous uveitis and TINU syndrome was diagnosed. Results: Because of renal insufficiency the patient was treated with systemic prednisone 50 mg ⁄ day for 3 weeks. Evolution was favourable, and prednisone was tapered over 10 weeks. Uveitis was treated with topical steroid with good effect. The only complication after 18 months of follow-up was transitory cushingoid aspect. Conclusions: Tubulointerstitial nephritis and uveitis syndrome is a rare syndrome that is probably underdiagnosed in clinical practice. Co-operation between ophthalmologists and nephrologists ⁄ paediatricians is crucial for early diagnosis and instigation of treatment. Uveitis may occur before tubulointerstitial nephritis or the renal symptoms may be so mild that the patient is unaware of them. Therefore, ophthalmologists play an important role in the initial discovery of patients with TINU syndrome. Tubulointerstitial nephritis tends to be self-limiting, whereas uveitis tends to relapse and recurrences tend to be more severe than the initial uveitis. Therefore, the patient must be ophthalmologically monitored very carefully.

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“…They also reported a possible link with HLA-DR6 [16]. There have also been reports of associations with ANCA [17], ANA [18], and hypocomplementemia [19]. …”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Tubulointerstitial Nephritis and Uveitis Syndrome Treated with a Multi-Specialty Approach

et al. 2016

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Patient: Female, 23Final Diagnosis: Tubulointerstitial nephritis and uveitis syndromeSymptoms: Abdominal pain • eye rednessMedication: —Clinical Procedure: —Specialty: OpthalmologyObjective:Rare diseaseBackground:It is important for an ophthalmologist and nephrologist to look for hidden causes of uveitis and nephritis, respectively. Delay in diagnosis leads to increased morbidity and failure to systemically manage the patient results in future recurrence of disease. It is likely that TINU remains underdiagnosed and could potentially account for some of the cases of idiopathic uveitis, especially when greater than 50% of uveitis cases have no identifiable cause.Fewer than 300 cases of tubulointerstitial nephritis and uveitis (TINU) syndrome have been reported. In TINU syndrome, inflammation affects the renal tubules, interstitial tissue, and uveal tract. Its pathogenesis remains poorly understood.Case Report:We report a rare case of TINU syndrome in a 23-year-old female who was treated using a multispecialty approach. Her primary care physician diagnosed her with proteinuria and acute kidney injury and referred her to the nephrologist, who later referred her to the ophthalmologist. A left kidney biopsy confirmed acute inter-stitial nephritis. Following the discovery of a “pink eye”, the patient was referred to ophthalmology and diagnosed with anterior uveitis, confirming TINU syndrome. Without the additional findings of uveitis, the diagnosis would have been missed. Resolution was obtained through steroid therapy.Conclusions:Correctly diagnosing TINU syndrome requires a multispecialty approach and may not be obvious upon initial presentation. Therefore, the ophthalmologist needs to consider TINU in the differential diagnosis for a patient with bilateral uveitis and evaluate a urinalysis for proteinuria as part of the work up.

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TINU Syndrome Associated with Reduced Complement Levels

Cited by 10 publications

References 5 publications

Tubulointerstitial nephritis and uveitis syndrome associated with hyperthyroidism

Tubulointerstitial nephritis and uveitis syndrome associated with hyperthyroidism

Tubulointerstitial nephritis and uveitis (TINU) syndrome: a case report and review of the literature

A Rare Case of Tubulointerstitial Nephritis and Uveitis Syndrome Treated with a Multi-Specialty Approach

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