Tubulointerstitial nephritis and uveitis syndrome in a female adult

Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease characterised by the association of acutetubulointerstitial nephritis and uveitis. It affects mainly children and young women. Drugs and infections may be precipitating factors. It is a diagnosis of exclusion. The mainstays of treatment are topical and systemic corticosteroids. Prognosis is usually favourable. We report a case of TINU which occurred in our unit. A 37-year-old woman presented with an influenza-like illness, bilateral ocular pain and blurred vision. Ophthalmological evaluation revealed bilateral anterior uveitis and later renal involvement was seen as acute tubulointerstitial nephritis. A diagnosis of TINU was assumed after exclusion of other systemic diseases. She was treated with topical corticosteroids for the uveitis and evolved favourably, with resolution of ocular symptoms and normalisation of serum creatinine and proteinuria. This case highlights the importance of a high degree of clinical suspicion to make the diagnosis of TINU syndrome.

Tubulointerstitial nephritis and uveitis syndrome in an adolescent female: a case report

“…Oral prednisone or prednisolone with a dosage of 1-1.5 mg/kg/day is usually used. The duration and schedule for tapering of steroid dose depends mainly on patient response [9,13,15,16,27]. Because of frequent relapses and recurrences of disease, some authors suggest at least 12 months of oral corticosteroid therapy [28], while others advocate an early and short course [29], which was the case in our patient.…”

“…If nephritis is mild or in remission, topical steroids may be used to treat uveitis, though not efficient in posterior intraocular segment involvement [9]. Systemic corticosteroids are generally reserved for cases of progressive renal involvement [3] and are needed in about 80% of patients [27]. Oral prednisone or prednisolone with a dosage of 1-1.5 mg/kg/day is usually used.…”

“…Because of frequent relapses and recurrences of disease, some authors suggest at least 12 months of oral corticosteroid therapy [28], while others advocate an early and short course [29], which was the case in our patient. We believe that, in the absence of evidence-based treatment protocols, a caseby-case management may be adopted [27].…”

Tubulointerstitial Nephritis and Uveitis Syndrome: A Report of 6 Cases with Renal Biopsy and Electron Microscopy Evaluation

“…In addition to oculo-renal involvement, 2 patients experienced constitutional symptoms, such as low fever and abdominal pain. Such a “flu-like syndrome” has been rarely encountered in TINU patients [25, 26], and in our cases, it could be explained based on the patients’ young age, which may predispose for a more robust systemic immune reaction. Concerning risk factors, 2 patients had received drugs, which could have served as triggers for TINU syndrome development.…”

A different presentation of tubulointerstitial nephritis and uveitis syndrome mimicking Sjögren’s syndrome

“…In the diagnostic approach to TINU syndrome, exclusion of diseases such as sarcoidosis and Sjögren’s disease is necessary since oculorenal involvement might be seen in the course of these diseases. [ 4 ] Although Sjögren’s disease might be suspected in this 55-year-old female patient with sicca symptoms,[ 5 ] salivary gland biopsy findings and the extractable nuclear antigen panel were not compatible with Sjögren’s disease. Additionally, as there was no granuloma formation in the kidney biopsy, TIN could not be attributed to sarcoidosis or Sjögren's disease.…”