Tubulointerstitial Nephritis and Uveitis Syndrome (TINU): A Case Series in a Tertiary Care Uveitis Setting

Abstract

Background: Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare disorder typically characterized by sudden-onset non-granulomatous anterior uveitis associated with tubulointerstitial nephritis (TIN). However, the prevalence and clinical features of TINU are still a matter of debate. To add information about TINU, we describe here the clinical features of a series of patients affected by TINU in a retrospective study. Methods: A total of 9358 clinical records of both adult and pediatric patients up to 21 years of age, referred to the Uveitis Center of the Sapienza University of Rome, were examined. The medical records covered a period from 1990 to 2020. Various demographic and clinical features were analyzed in patients who met the criteria for TINU. Results: Twenty-one patients with TINU were identified. TINU was classified as definite, possible, or probable by the currently recognized international criteria. The median age at diagnosis was 14 years (interquartile range 12–35). Females were predominant (15/21, 71.4%). In most cases (14/21, 66.6%), patients developed ocular disease concurrently with renal disease. The most frequent type of ocular involvement was bilateral anterior uveitis (9/21, 42.8%). In two cases, patients presented with bilateral intermediate uveitis; in three cases, they presented with bilateral or unilateral alternating posterior uveitis; and in four cases, they presented with bilateral panuveitis. In one case, the uveitis was anterior in the right eye (OD) and posterior in the left eye (OS), and two cases presented with bilateral asynchronous or unilateral alternating anterior uveitis. All patients received treatment with systemic corticosteroids and topical ocular therapy. At the end of the follow-up, a significant improvement in ocular signs and symptoms with a return to normal visual acuity was generally observed. In all patients, acute kidney injury (AKI) reverted completely and none progressed to chronic kidney disease (CKD). Conclusions: Patients with TINU may often present with atypical uveitis. We suggest that patients with sudden-onset uveitis, even if not bilateral anterior, should be referred to a nephologist for an assessment of the possible presence of renal disease.

Diagnosis and Treatment of Uveitis in Children: A Summary of the Latest Data from a 5-Year Literature Review (2018–2023)

“…The clinical presentation of uveitis can provide diagnostic clues to facilitate the identification of the relevant disease entity underpinning the ongoing inflammatory process in the eye. Table 2 [ 2 , 13 , 19 , 20 ] and Table 3 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] list the symptoms characteristic of uveitis for each disease entity, categorized by infectious and non-infectious agents.…”

“…Bilateral nonmelanomatous inflammation primarily of the anterior uvea that occurred less than 2 months before or 12 months after the onset of interstitial nephritis in the absence of other more likely causes to explain the eye or kidney pathology [24].…”

TINU syndrome - literature review

“…W badaniu 31 pacjentów z zespołem TINU przeprowadzonych przez Li i wsp., 20 (65%) zażywało leki przed rozwojem choroby, z czego 12 więcej niż jedno lekarstwo, 1 chińskie zioła, 1 niesteroidowe leki przeciwzapalne, a 6 wyłącznie antybiotyki (między innymi B-laktamy, meropenem, azytromycynę i lewofloksacynę) [11]. Podobne badanie retrospektywne przeprowadzone we Włoszech również wykazało, że 4/21 pacjentów przyjmowało antybiotyk w czasie poprzedzającym rozwój TINU [17]. Znany jest też przypadek pacjenta, u którego za rozwój zespołu TINU mógł być odpowiedzialny flubiprofen [18].…”

Acute neuroretinitis as a delayed manifestation of tubulointerstitial nephritis and uveitis syndrome

“…However, multiple recent case series and systematic reviews support that the ocular manifestations of TINU can extend beyond anterior uveitis to involve the intermediate and posterior segments. 2 , 5 , 6 Additional case reports have described other manifestations of posterior uveitis including retinal pigment epithelium detachments, subfoveal choroidal neovascularization, multifocal choroiditis, and chorioretinal scarring. 7 , 8 , 9 , 10 …”