Tubulointerstitial Nephritis and Uveitis Syndrome in Children: A Prospective Multicenter Study

Saarela, Ville; Nuutinen, Matti; Ala‐Houhala, Marja; Arikoski, Pekka; Rönnholm, Kai; Jahnukainen, Timo

doi:10.1016/j.ophtha.2012.12.039

Cited by 54 publications

(54 citation statements)

References 17 publications

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“…More than half of the patients (58%) had lateonset uveitis and would be clinically difficult to detect unless the patients were followed longitudinally. 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.…”

Section: Discussionsupporting

confidence: 88%

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%

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Chu

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…No granuloma is found. Typical bilateral anterior uveitis concurrent with or preceding or following the onset of renal dysfunction corroborates the diagnosis of TINU (7,8).…”

Section: Participantssupporting

confidence: 58%

The ratio of urinary α1-microglobulin to microalbumin can be used as a diagnostic criterion for tubuloproteinuria

Zhang

Wang

et al. 2018

IRDR

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“…The renal course is thought to be independent from ocular disease as neither the severity nor the prognosis of nephritis is influenced by the presence of uveitis [3*,9]. Asymptomatic uveitis in the context of pediatric tubulointerstitial nephritis may be under-recognized, with one prospective study identifying uveitis in 50% of patients with biopsy-proven interstitial nephritis in [10]. However, no guidelines or recommendations for proactive ocular screening in patients with interstitial nephritis have been made to date.…”

Section: Presentationmentioning

confidence: 99%

“…This further supports the importance of collaborating with nephrology colleagues for case-by-case management decisions and to ensure patients are benefitting from the most current treatment guidelines. Fortunately, however, once in remission (spontaneous or after treatment), renal recurrences rarely occur [2-5*,10,31**]. …”

Section: Prognosis and Treatmentmentioning

confidence: 99%

Tubulointerstitial nephritis and uveitis

Pakzad-Vaezi

Pepple

2017

Current Opinion in Ophthalmology

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Purpose of review Tubulointerstitial nephritis and uveitis (TINU) is an important yet under-recognized ocular inflammatory syndrome. This review summarizes key historical publications that identified and defined the syndrome, and more recent literature that reveal the importance of urinary beta-2 microglobulin testing and kidney biopsy in the diagnostic evaluation of patients with TINU. Additionally, research studies providing new insights into disease pathogenesis are highlighted. Recent findings In contrast with initial reports of TINU manifesting exclusively as an anterior uveitis in pediatric patients, more recent reports have identified TINU in patients of all ages with a wide range of ocular manifestations. Urinary beta-2 microglobulin has emerged as a sensitive and specific laboratory screening test, and the role of kidney biopsy in differentiating TINU from sarcoidosis continues to evolve. Genetic studies have identified HLA-DQA1*01, HLA-DQB1*05, and HLA-DRB1*01 as high risk alleles and the identification of anti-mCRP antibodies suggests a role for humoral immunity in disease pathogenesis. Management strategies have evolved to include systemic anti-inflammatory treatment as a result of important outcome studies in patients with significant renal and ocular disease. Summary With greater recognition, understanding, and treatment of this syndrome, both ocular inflammation and renal disease can be better addressed.

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Tubulointerstitial Nephritis and Uveitis Syndrome in Children: A Prospective Multicenter Study

Cited by 54 publications

References 17 publications

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

The ratio of urinary α1-microglobulin to microalbumin can be used as a diagnostic criterion for tubuloproteinuria

Tubulointerstitial nephritis and uveitis

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