Tubulointerstitial nephritis and uveitis in association with Epstein-Barr virus infection

Abstract

The case of a 13.5-year-old girl with acute tubulointerstitial nephritis and uveitis (TINU syndrome) is presented. The etiology of this rare syndrome, which in most cases involves female adolescents and usually regresses spontaneously, is still unknown. An infection-triggered pathological immune reaction has been considered to play a role in the pathogenesis of this disorder. Here we report for the first time the association of TINU syndrome and Epstein-Barr virus infection.

Tubulointerstitial Nephritis And Uveitis Syndrome With Symmetrical Synovitis In A Male Adolescent

“…Corticosteroids seem essential in treating these patients (9,10). However, systemic steroid therapy does not seem necessary for all patients, there is some evidence that renal function may improve more rapidly in steroid-treated patients (2,3,8). Our patient had bilateral uveitis, significant tubulointerstitial injury and decreased renal function.…”

“…Acute intertitial nephritis has been associated with a wide variety of drugs, toxins, infectious agents and autoimmune disorders (7,8). Biochemical abnormalities include increased serum creatinine levels, erythrocyte sedimentation rate, immunoglobulins, and anemia.…”

Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome, Two New Cases and Review of the Literature

“…In 1985, this disease was named tubulointerstitial nephritis and uveitis syndrome (TINU) syndrome by Grefer and Dusek et al [15,16]. Most patients subsequently reported had a combination of TIN and uveitis without granulomas, and are presently included in TINU syndrome [17].…”

“…The antigenic insult within the renal parenchyma could also attract an eosinophilic and mononuclear response, with concurrent activation of lymphatic and bone marrow histiocytes leading to the granuloma formation [21]. The possibility of a suppression of cellular immunity has also been suggested [15,19]. Thus, analogous to sarcoidosis, the systemic immune response may be suppressed, while locally there seems to be vigorous immune reactivity in the uvea and kidney.…”

“…In some reports, infection-triggered pathological immune reaction was suggested to play a role in the pathogenesis of TINU syndrome [32]. However, infectious agent could not be found in most cases in the literature, although there have been reports of the association of TINU syndrome and toxoplasmosis, chlamydial and EBV infection [15]. In terms of medications, antibiotic use is the most commonly identified risk factor for the development of TINU syndrome followed by nonsteroidal anti-inflammatory drug (NSAID) use [9].…”