1
|
Regusci A, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F. Tubulointerstitial nephritis and uveitis syndrome: a systematic review. Nephrol Dial Transplant 2022; 37:876-886. [PMID: 33561271 DOI: 10.1093/ndt/gfab030] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis (TIN) and uveitis in the absence of other systemic diseases. The most comprehensive review on this condition was published in 2001. METHODS We conducted a systematic review of the literature for cases of TINU syndrome. MEDLINE and Embase databases were screened. Full-length articles or letters reporting cases with both TIN and uveitis were selected. We investigated differences between males and females and paediatric and adult cases. Multivariate analysis was performed to identify potential risk factors for chronic kidney disease (CKD) development. RESULTS A total of 233 articles reporting 592 TINU cases were retained for the analysis. The median age of the included subjects was 17 years (interquartile range 13-46) with a female predominance (65%). Uveitis most frequently (52%) followed renal disease and was mostly anterior (65%) and bilateral (88%). Children tended to have more ocular relapses, while they were slightly less likely than adults to suffer from acute kidney injury and to develop CKD. Adult age as well as posterior or panuveitis were associated with an increased risk of developing CKD. CONCLUSIONS TINU affects both children and adults, with some differences between these two categories. Adult age and the presence of a posterior uveitis or panuveitis appear to be associated with the development of CKD.
Collapse
Affiliation(s)
- Alessia Regusci
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Federica Vanoni
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| |
Collapse
|
2
|
Legendre M, Devilliers H, Perard L, Groh M, Nefti H, Dussol B, Trad S, Touré F, Abad S, Boffa JJ, Frimat L, Torner S, Seidowsky A, Massy ZA, Saadoun D, Rieu V, Schoindre Y, Heron E, Frouget T, Lionet A, Glowacki F, Arnaud L, Mousson C, Besancenot JF, Rebibou JM, Bielefeld P. Clinicopathologic characteristics, treatment, and outcomes of tubulointerstitial nephritis and uveitis syndrome in adults: A national retrospective strobe-compliant study. Medicine (Baltimore) 2016; 95:e3964. [PMID: 27367994 PMCID: PMC4937908 DOI: 10.1097/md.0000000000003964] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, defined by the association of idiopathic acute TINU. The aim of our work was to determine the characteristics of adult TINU syndrome in France, and to assess factors (including treatment) influencing medium-term prognosis.We conducted a nationwide study including 20 French hospitals. Clinical, laboratory, and renal histopathologic data of 41 biopsy-proven TINU syndromes were retrospectively collected. The patients were diagnosed between January 1, 1999 and December 1, 2015.Twenty-five females and 16 males were included (F/M ratio: 1.6:1). The median age at disease onset was 46.8 years (range 16.8-77.4) with a median serum creatinine level at 207 μmol/L (range 100-1687) and a median estimated glomerular filtration rate (eGFR) at 27 mL/min per 1.73 m (range 2-73). Twenty-nine patients (71%) had a bilateral anterior uveitis and 24 (59%) had deterioration in general health at presentation. Moderate proteinuria was found in 32 patients (78%) (median proteinuria 0.52 g/24 h; range 0.10-2.10), aseptic leukocyturia in 25/36 patients (70%). The evaluation of renal biopsies revealed 41 patients (100%) with an acute tubulointerstitial nephritis, 19/39 patients (49%) with light to moderate fibrosis and 5 patients (12%) with an acute tubular necrosis. Thirty-six patients (88%) were treated with oral corticosteroids. After 1 year of follow-up, the median eGFR was 76 mL/min per 1.73 m (range 17-119) and 32% of the patients suffered from moderate to severe chronic kidney disease. Serum creatinine (P < 0.001, r = -0.54), serum bicarbonate and phosphate levels (respectively, P = 0.01, r = 0.53; and P = 0.04, r = 0.46), and age (P = 0.03, r = -0.37) at the 1st symptoms were associated with eGFR after 1 year. During the 1st year 40% of patients had uveitis relapses. The use of oral corticosteroids was not associated with a better kidney function but was associated with fewer uveitis relapses (P = 0.44 and 0.02, respectively).In our study, 32% of patients were suffering from moderate to severe chronic kidney disease after 1 year of follow-up, and 40% had uveitis relapses during this follow-up. This work also suggests that oral corticosteroids are effective for the treatment of TINU syndrome's uveitis.
Collapse
Affiliation(s)
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Department, Bocage University Hospital, Dijon
| | - Laurent Perard
- Internal Medicine Department, Edouard Herriot University Hospital and University Claude Bernard Lyon 1, Lyon
| | - Matthieu Groh
- Internal Medicine Department, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin University Hospital and University Paris Descartes, Paris
| | | | - Bertrand Dussol
- Nephrology Department, La Conception University Hospital and University Aix-Marseille, Marseille
| | - Salim Trad
- Internal Medicine Department, Ambroise-Paré University Hospital, Paris
| | - Fatouma Touré
- Nephrology Department, Maison Blanche University Hospital, Reims
| | - Sébastien Abad
- Internal Medicine Department, University Hospital Avicenne and University Sorbonne, Paris
| | | | - Luc Frimat
- Nephrology Department, Brabois University Hospital and INSERM CIC-EC CIE6, Nancy
| | | | - Alexandre Seidowsky
- Nephrology Department, Ambroise-Paré University Hospital, Boulogne-Billancourt
| | - Ziad André Massy
- Nephrology Department, Ambroise-Paré University Hospital, Boulogne-Billancourt
| | - David Saadoun
- Internal Medicine and Clinical Immunology Department, Pitié Salpetriere University Hospital and DHU Inflammation, Immunopathology, Biotherapy, Paris VI
| | - Virginie Rieu
- Internal Medicine Department, University Hospital Clermont Ferrand, Clermont-Ferrand
| | - Yoland Schoindre
- Internal Medicine and Clinical Immunology Department, Pitié Salpetriere University Hospital and DHU Inflammation, Immunopathology, Biotherapy, Paris VI
| | - Emmanuel Heron
- Internal Medicine Department, Quinze-Vingts Ophthalmogy Hospital, Paris
| | | | - Arnaud Lionet
- Nephrology Department, University Hospital Claude Huriez, Lille
| | | | - Laurent Arnaud
- Rheumatology Department, National Referral Center for Rare Autoimmune Diseases, Strasbourg University Hospital, and UMR 1109, Strasbourg, France
| | | | | | | | - Philip Bielefeld
- Internal Medicine and Systemic Diseases Department, Bocage University Hospital, Dijon
- Correspondence: Philip Bielefeld, Internal Medicine and Systemic Diseases Department, Bocage University Hospital, Service de Médecine 2, 14 rue Paul Gaffarel, CHU Dijon, 21033 Dijon Cedex, France (e-mail: )
| |
Collapse
|