Evidence exists of hla antigenrelated genetic predisposition to developing tinu. The renal function was normal in these patients after 24 and 27 months of followup, respectively. Introduction the tubulointerstitial nephritis and uveitis syndrome tinu is a speci. Intermediate uveitis iu is a chronic, relapsing disease of insidious onset. Tubulointersticial nephritis and uveitis tinu syndrome is a rare. Based on previous studies, adults with isolated idiopathic uveitis have polymorphisms in interleukin 10 il10 and tumor necrosis factor. Tubulointerstitial nephritis and uveitis wikipedia. Tubulointerstitial nephritis and uveitis with fanconi syndrome. Tubulointerstitial nephritis and uveitis syndrome in an elde. Mabrouk ar, nephrology dialysis renal transplantation department, annaba university hospital, algeria. Immunomodulatory therapy for chronic tubulointerstitial.
Tubulointerstitial nephritis and uveitis syndrome tinu syndrome is an uncommon clinical entity, and the majority of patients are. There are potential diagnostic markers, such as serum kl6 and urinary. The anterior uveitis of tinu is treated with topical steroids and cycloplegic agents to avoid the development of posterior synechiae. To investigate the clinical manifestations, prognosis, and hlatype of tubulointerstitial nephritis and uveitis syndrome tinu with longterm followup. Mycophenolate mofetil for the treatment of interstitial nephritis. Further treatment with topic and oral corticosteroids for a total of 21 weeks. Topical steroids associated with cycloplegic agents are commonly recommended as a treatment option for anterior uveitis. The pathogenesis of tinu syndrome remains unclear, it affects predominantly adolescents. The tubulointerstitial nephritis and uveitis tinu syndrome. The tubulointerstitial nephritis and uveitis syndrome to the. Tubulointerstitial nephritis and uveitis syndrome tinu is a rare immunological disorder occuring in less than 2% of cases of uveitis.
Patients and methods the charts of all patients with tinu seen by dr. The patient partially responded to corticoid treatment. Letters to the editor 84 letters to the editor the tinu syndrome sir, we write in response to uveitis. Sep 12, 2014 tubulointerstitial nephritis and uveitis syndrome is a disorder characterized by a combination of acute tubulointerstitial nephritis and uveitis. Differential diagnosis of acute bilateral uveitis in the. Tubulointerstitial nephritis and uveitis tinu syndrome is a relatively uncommon disease combined with the development of acute tubulointerstitial nephritis ain and uveitis.
Information regarding age, sex, race, renal biopsy results, interval between kidney and eye involvement, type of uveitis, topical and oral treatment for uveitis, visual acuity at presentation. Cogans syndrome is a rare autoimmune disease with nonsyphilitic interstitial keratitis and auditoryvestibular symptoms occurring within 2 years, sometimes associated with largevessel vasculitis 3, 4. Which diagnosis is most likely in internal medicine. The syndrome of tubulointerstitial nephritis with uveitis. The tubulointerstitial nephritis and uveitis tinu syndrome is associated with hladr14 in spanish patients article pdf available in british journal of ophthalmology 858. Tinu syndrome should be considered in the differential diagnosis of uveitis with constitutional symptoms. Renal biopsy showed a tubulointerstitial nephritis, with. Since then, some 50 cases 35 paediatric patients and 15 adults have been described.
Uveitis in the setting of tinu syndrome appears to be more persistent and troublesome than the nephritis 4. Tubulointerstitial nephritis and uveitis tinu syndrome is a rare oculorenal inflammatory condition that was first described in 1975. First, this is the first reported case of iga nephropathy complicated by tinu syndrome with. Three cases of tubulointerstitial nephritis and uveitis. The tubulointerstitial nephritis and uveitis syndrome to. Referral to an ophthalmology specialist is indicated for the diagnosis and management of most patients with symptoms suggesting uveal tract inflammation. S ir, tinu syndrome is a rare autoimmune condition with acute tubulointerstitial nephritis and uveitis 1, 2. Tubulointerstitial nephritis with uveitis syndrome. Tubulointerstitial nephritis, uveitis, hearing loss and. A 39yearold man presented with a 6month history of lethargy and generalized arthralgia. Tubulointerstitial nephritis and uveitis tinu syndrome is. Tubulointerstitial nephritis and uveitis syndrome in an. Acute tubulointerstitial nephritis and anterior uveitis tinu. Clinical evaluation, serologic testing, and renal biopsy were performed on a 16 yearold boy who presented with bilateral visual loss and constitutional symptoms.
Mullan1 1nephrology unit, antrim area hospital, 45 bush road, antrim, bt41 2rl, 2regional nephrology unit and 3department of. Immunoglobulin a nephropathy is defined by the presence of immunoglobulin a deposits in glomerular mesangial areas. In this report, we describe a rare case of tubulointerstitial nephritis and uveitis syndrome complicated by immunoglobulin a. Tinu syndrome 1 complicated by iga nephropathy, she was given methylprednisolone for three days with subsequent oral prednisolone for two months, with clinical improvement. Background tubulointerstitial nephritis tin and uveitis syndrome tinu are likely to be autoimmune diseases. The role of infections and noninfectious causes is speculated in the immune response, leading to the development of the syndrome.
Pdf the tubulointerstitial nephritis and uveitis tinu. Dobrin or tinu syndrome is rare, and must be considered in patients who present with acute tubular interstitial editor note. Tubulointerstitial nephritis and uveitis syndrome tinu. Editor,an uncommon association between tubulointerstitial nephritis and anterior uveitis was described in two adolescent female patients with noncaseating granulomas in both bone marrow and lymph nodes by dobrin1 and is referred to as tinu syndrome. The most common signs and symptoms of uveitis include photophobia, eye pain and redness, eyelid edema and progressive loss of. Tubulointerstitial nephritis and uveitis tinu syndrome. To report a case of tubulointerstitial nephritis associated with uveitis tinu syndrome associated with epsteinbarr virus, which presented aggressive bilateral uveitis. Thus, it is very important that the study of these patients include the determination of renal function and urinalysis.
Diagnosis requires the presence of both tubulointerstitial nephritis and uveitis. Tubulointerstitial nephritis tin with uveitis tinu is a rare disease whose pathogenesis is unknown. Tubulointerstitial nephritis and uveitis syndrome tinu is a rare syndrome less than 12% of all patients seen by ophthalmologists, that was first described in 1975 1. According to the standardization of uveitis nomenclature sun working group criteria, iu is defined as an intraocular inflammation mainly focused on the vitreous and peripheral retina. We report a case of an acute renal insufficiency at a 42 years old woman whose exploration favors the diagnosis of a tinu syndrome. We here describe three different clinical manifestations of tubulointerstitial nephritis and uveitis tinu syndrome. When a systemic condition is suspected collaboration with physicians is advisable. Another study by the same group confirmed that the mcrp is higher among patients with tinu syndrome and lateonset uveitis compared with those with druginduced interstitial nephritis 3. Tubulointerstitial nephritis and uveitis syndrome tinu is a disease in which idiopathic acute tubulointerstitial nephritis tin is complicated by uveitis. Pdf similar articles controversy regarding paracetamol and codeine phosphateinduced acute tubulointerstitial nephritisuveitis tinu syndrome onur. Tubulointerstitial nephritis and uveitis syndrome in a twelve. Bilateral involvement further limits the alternatives to spondyloarthropathies, behc. Meyrier tubulointerstitial nephritis and uveitis tinu syndrome. Laidoudi aicha, a ghout, s medaoud, d hakem, a boudjelida, f haddoum, k kallem and a berrah.
Presence of autoantibodies against tubular and uveal cells in a patient with tubulointerstitial nephritis and. Tubulointerstitial nephritis and uveitis tinu is a rare medical condition in which there is uveitis inflammation of the uvea in the eye together with tubulointerstitial nephritis inflammation of the tubules inside the kidney. Tinu syndrome pathology and etiology remains a challenge, and we hope that the increasing awareness and interest on it will help to solve it. Tubulointerstitial nephritis with uveitis tinu syndrome is an unusual and under diagnosed cause of acute interstitial nephritis. It was first reported by dobrin et al 1 in 1975, since then, many clinicians have submitted case reports to journals around the world.
The tubulointerstitial nephritis and uveitis syndrome to the editor article in survey of ophthalmology 473. Clinical and genetic features of tubulointerstitial nephritis. Tubulointerstitial nephritis and uveitis tinu syndrome uptodate. We would like to present our observation of tinu in an adolescent boy with chronic renal inflammation.
Tubulointerstitial nephritis and uveitis syndrome complicated. We present a rare case of an elderly patient, who had been suffering from a fever for 2 weeks, characterized by sudden onset and resolving spontaneously, and accompanied by extreme fatigue, loss of appetite, and shivering. Tubulointerstitial nephritis and uveitis tinu syndrome is a rare disorder defined by the combination of biochemical abnormalities, tubulointerstitial nephritis, and uveitis. Pdf tubulointerstitial nephritis and uveitis tinu syndrome. The resulting inflammation affects chiefly the ocular uvea and renal tubules, although other organs may be.
The interstitial nephritis may precede, follow or develop concurrent to the uveitis. The syndrome of tubulointerstitial nephritis and uveitis tinu is a multisystemic autoimmune disorder that may occur in response to various environmental triggers, including drugs and microbial pathogens. Case report open access tubulointerstitial nephritis and. Tinu syndrome, through two observations 5 th global nephrologists annual meeting march 31april 02, 2016 valencia, spain. Neonate born to hepatitis b carrier mother presenting with congenital onychodysplasia of the index finger isokikuchi syndrome hiro matsukura, yoko oose, hiroyoshi yuki abstract full text.
We describe a 12yearold female, presented with a tenday history of fever, characterized by sudden onset and rapid spontaneous resolution in few hours, accompanied by shivering, extreme fatigue, and loss of appetite. We examined and diagnosed the following 3 patients. The prognosis for patients with tinu is generally good with steroid treatment. Controversy regarding paracetamol and codeine phosphate.
He had received topical treatment for suddenonset bilateral anterior uveitis 6 weeks. The syndrome of tubulointerstitial nephritis with uveitis tinu. Epidemiology the true prevalence of this syndrome is unknown, likely secondary to poor recognition of the disease 2. Jun 29, 2018 suzuki h, yoshioka k, miyano m, et al. The true prevalence of this syndrome is unknown, likely secondary to poor recognition of the disease 2. An increasingly recognized entity is tubulointerstitial nephritis with uveitis tinu syndrome. The inflammation in tinu syndrome is thought to be tlymphocyte driven, based upon the histologic findings. Discussion in this case, we made two important clinical observations. Editor inchief neal adams, md, associate professor of ophthalmology, department of ophthalmology, georgetown university, washington, dc, usa and johns hopkins university suburban hospital, bethesda, md, usa. The incidence of tinu syndrome may be increasing and the epidemiology is possibly changing with a higher proportion of men and older persons affected. Praga m, appel gb, palevsky pm editor alice m sheridanclinical. Tinu syndrome is thought to be an autoimmune disease, first described by dobrin et al.