Tubulointerstitial nephritis and uveitis

Abstract

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.

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

“…This report described three cases of TINU syndrome, a rare condition with few published cases. 1 , 3 , 6 …”

“…Nephritis may be diagnosed based on clinical criteria, including factors such as decreased GFR, alterations in urinalysis (raised urine β2-microglobulin levels, hematuria, non-nephrotic proteinuria, glucosuria, pyuria, urine eosinophils and leukocyturia), and systemic alterations (fever, asthenia, weight loss, exanthema, abdominal and flank pain, arthralgia, myalgia and laboratorial findings such as anemia, eosinophilia, increased ESR and changes in liver function). 1 Albeit not mandatory, renal biopsy may be performed to confirm the diagnosis. 1 , 4 …”

“…Tubulointerstitial nephritis may be asymptomatic or associated with systemic symptoms, arthralgia, myalgia, abdominal and back pain, and nocturia. 1 , 2 , 3 It precedes uveitis in 65% of the cases. 4 , 7 In patients 1 and 2, renal function was assessed only after the patients had been diagnosed with uveitis; then the diagnosis of tubulointerstitial nephritis was established.…”

“…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 …”

“…The syndrome accounts for approximately 5% of the cases of tubulointerstitial nephritis 5 and less than 2% of the cases of uveitis, and for a third of the cases of pediatric bilateral anterior uveitis. 1 , 2 …”