Tubulointerstitial Nephritis and Uveitis Syndrome: Case Report and Review of the Literature

Abstract

Purpose:To review the literature on tubulointerstitial nephritis and uveitis (TINU) syndrome, and to report a case of a patient with relapsing polychondritis (RP) and TINU syndrome. Method: TINU syndrome is a rare oculo-renal inflammatory disorder. It is more common in young women with autoimmune conditions, infections, systemic disease, and previous use of medications. We report the case of a 62-year-old woman with relapsing polychondritis and a 2-year history of acute, recurrent, asymmetric, bilateral, anterior, nongranulomatous uveitis accompanied by tubulointerstital nephritis. The patient was diagnosed with TINU syndrome associated with relapsing polychondritis. No cases of this association have been reported in the literature. The clinical features of TINU syndrome are discussed based on the published works. Conclusion: TINU is an uncommon syndrome; only about 200 cases have been reported in the literature related to infections, systemic disease, and previous use of medications such as antibiotics and non-steroidal anti-inflammatory drugs. We found that it can be associated with relapsing polychondritis; therefore, it is important to investigate symptoms of this disease since TINU syndrome can co-exist with it.

Uveitis in Children and Adolescents

“…Aguilar et al 34 described a 62-year-old woman from Bogotá, Colombia, who developed histopathologically confirmed TINU, an uncommon condition in the elderly, in the setting of relapsing polychoondritis -an association not reported previously. As with many patients with TINU, the patient had mild, bilateral, non-granulomatous, anterior uveitis, ultimately requiring the administration of a systemic immunosuppressive agent, mycophenolate mofetil, to achieve lasting control.…”

“…21 Moreover, while the etiology of the inflammation remains indeterminate, referred to as idiopathic by some or undifferentiated by others, in a sizable minority of patients, identified causes of uveitis clearly differ in young patients compared with adults. By definition, juvenile idiopathic arthritis (JIA) [22][23][24][25][26][27][28] presents in children, for example, and adolescents are much more likely to develop intermediate uveitis/pars planitis [29][30][31] or tubulointerstitial nephritis with uveitis (TINU) [32][33][34] than are either the middle-aged or elderly. Children also develop a disproportionate burden of infectious uveitis, 19,35 much of which is posterior, including toxoplasmic retinochoroiditis, necrotizing herpetic retinitis, toxocariasis, and both Bartonella henselae and nematode-associated neuroretinitis.…”

“…40 Unique treatment issues, particularly the management of cataracts to minimize the risk of amblyopia 41,42 and judicious use of systemic corticosteroids to avoid growth retardation, are also encountered. 43,44 Three reviews, 34,45,46 seven original articles, [47][48][49][50][51][52][53] and two letters 54,55 in this issue of Ocular Immunology & Inflammation (OII) address important aspects of the causes, management, complications, and outcomes of uveitis in children and adolescents.…”

“…As with many patients with TINU, the patient had mild, bilateral, non-granulomatous, anterior uveitis, ultimately requiring the administration of a systemic immunosuppressive agent, mycophenolate mofetil, to achieve lasting control. As summarized by the authors 34 and others, [56][57][58][59] TINU constitutes 1-2% of patients seen at uveitis referral centers, and is particularly common in children and adolescents who develop bilateral anterior uveitis of sudden onset. Frequent systemic symptoms include fever, fatigue or malaise, and abdominal pain.…”

Tubulointerstitial nephritis and uveitis syndrome in children: report of three cases

“…Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare condition 1 , 2 characterized by ocular and renal inflammation in the absence of other systemic diseases, recognized by diagnosis of exclusion. 1 , 3 , 4 Diagnosing patients with TINU syndrome is no simple task, since the manifestations tied to the condition may not occur concurrently. 2 …”