Tubulointerstitial nephritis and uveitis (TINU) syndrome: a case report and review of the literature

Thomassen, Veronica Holm; Ring, Troels; Thaarup, Jesper; Baggesen, Kirsten Lau

doi:10.1111/j.1755-3768.2008.01302.x

Cited by 36 publications

(42 citation statements)

References 19 publications

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“…12 In Japan, TINU syndrome is the second most frequent diagnosis in children with uveitis after sarcoidosis and in Europe TINU syndrome has been reported in Spain, France, Belgium, Italy, Poland, Germany, Austria, Switzerland, the Czech Republic, the UK, Serbia, Croatia, and Greece. 13 Generally, renal involvement in TINU is mild, whereas the uveitis tends to recur in some patients. 3 No racial predilection has been identified.…”

Section: Epidemiologymentioning

confidence: 99%

“…The uveitis tends to be bilateral, anterior, and nongranulomatous, but cases of unilateral or granulomatous uveitis and involvement of the intermediate or posterior segment and panuveitis have been reported. 13 The uveitis is most often symptomatic, with pain and photophobia. 1 In most cases, nephritis precedes uveitis, however in 21% of cases uveitis is present before nephritis and in 15%, the two conditions occur simultaneously.…”

Section: Clinical Spectrummentioning

confidence: 99%

“…6,13 In a retrospective case series of 1,985 patients with uveitis, individuals with TINU represented 1.7% of all patients with uveitis (n = 33). 12 The course of the disease was persistent over a median of 7 months (range, 1-147), after which the inflammation resolved in five patients (15%) (1, 8, 12 and 24 months).…”

Section: Prognosismentioning

confidence: 99%

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

Aguilar¹,

Lonngi²,

de-la-Torre

2015

Ocular Immunology and Inflammation

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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.

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Section: Epidemiologymentioning

confidence: 99%

Section: Clinical Spectrummentioning

confidence: 99%

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

Aguilar¹,

Lonngi²,

de-la-Torre

2015

Ocular Immunology and Inflammation

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“…The renal prognosis has been considered to be favorable, although this was largely based on case reports or retrospective studies of a small number of patients (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The long-term outcome of TINU syndrome, especially in adults, has not been well studied.…”

Section: Introductionmentioning

confidence: 99%

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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“…It has been reported in identical twins (boys or girls) and two pairs of sisters so far [27][28][29] and two generations of the same family [16] and no reports of geographic clustering of TINU syndrome cases [19,30]. This fact argues against either environmental or genetic factors as dominant influences in the pathogenesis of the disease [19].…”

Section: Discussionmentioning

confidence: 89%

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

Laidoudi¹,

Hakem²

2016

J Nephrol Ther

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Case 1: A 25 year-old woman, presented with asthenia; weight loss; severe hypertension and acute unilateral anterior uveitis. She had also proteinuria; hematuria; aciduria; kidney failure and grade I hypertensive retinopathy. Kidney biopsy showed a non caseating granuloma in the interstitial tissue, and tubulointerstitial nephritis (TIN) with granulomatous lesions in the medullary parenchyma. All explorations were negative but QuantiFERON was 10 times normal without koch's bacillus. No other sites of granulomas. The patient partially responded to corticoid treatment. She replased after untimely stopping corticosteroids. Corticosteroid-sparing was provided by mycophenolate mofetil.Case 2: A 46 year-old patient, with family history of mother who died of CKD, presented with recurrent anterior uveitis, kidney failure, proteinuria, and inflammatory syndrome, research of infectious agents or auto-immunity origin was negative. Renal biopsy showed TIN lesions in subacute stage; biopsy of the salivary glands showed stage III chronic lymphocytic sialadenitis without Sjogren syndrome or sarcoidosis. The patient received corticosteroid treatment. Discussion:The presence of TIN, recurrent anterior uveitis, no notion of drug intake, response to corticosteroids and exclusion of other diagnoses leads to TINU syndrome. Positivity of Quantiferon is explained by the fact that TINU syndrome is associated with high serological markers in the absence of their corresponding diseases, and presence of chronic lymphocytic sialadenitis explained by these immunological disorders without Sjogren syndrome, Both patients remained well without recurrence of uveitis 2 and 6 years later respectively. Conclusion:TINU syndrome is secondary to immunological disorders as evidenced interstitial infiltrate of the renal parenchyma, the inflammatory disease of the uvea and good response to corticosteroid therapy.

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Tubulointerstitial nephritis and uveitis (TINU) syndrome: a case report and review of the literature

Cited by 36 publications

References 19 publications

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

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

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

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

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