1
|
Huang L, Kim DT, Rosenberg CR, Lin P, Suhler E. Diagnosis and Characteristics of Presentation of Tubulointerstitial Nephritis and Uveitis Syndrome During the COVID-2019 Pandemic. Ocul Immunol Inflamm 2024; 32:1351-1358. [PMID: 37699166 PMCID: PMC10927609 DOI: 10.1080/09273948.2023.2244077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/12/2023] [Accepted: 07/30/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To compare the diagnosis and clinical features of tubulointerstitial nephritis and uveitis syndrome (TINU) before and during the COVID-19 pandemic. METHODS Retrospective chart review. RESULTS Before the COVID-19 pandemic (March 2017 to March 2019), 1/561 (0.18%) new patient was diagnosed with TINU. During the pandemic (March 2020 to March 2022), 15/581 (2.58%) new patients were diagnosed with TINU. We found a significant increase in TINU cases during the pandemic (P=0.0005). Various posterior segment findings were observed in 2/3 (66.7%) patients before the pandemic and 13/15 (86.7%) patients during the pandemic, including disc edema, chorioretinal scars, disc leakage, and peripheral vascular leakage. CONCLUSION This is the first study reporting an increased number of TINU during the COVID-19 pandemic. With most of the American population now exposed to COVID-19, a large multi-center epidemiological study would be helpful to investigate any association of COVID-19 disease or vaccination with TINU in recent years.
Collapse
Affiliation(s)
- Lingling Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - David Ta Kim
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- VA Portland Health Care System, Portland, OR, USA
| |
Collapse
|
2
|
Pichi F, Aljeneibi S, Neri P. Tubulointerstitial Nephritis and Uveitis Syndrome in the United Arab Emirates. Ocul Immunol Inflamm 2024; 32:578-582. [PMID: 36794345 DOI: 10.1080/09273948.2023.2178939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To report the first series of tubulointerstitial nephritis (TINU) syndrome from the Middle East. METHODS We retrospectively included patients with elevated urine beta-2 microglobulin, and a diagnosis of TINU based on anterior uveitis with or without posterior involvement. Multimodal imaging, duration of follow-up, local and systemic treatment used were recorded. RESULTS 24 eyes of 12 patients (8 male, mean age 20.3 years) met the criteria for TINU. The most common posterior segment clinical finding was optic nerve head edema (41.7%), while on fluorescein angiography 58.3% and 75% of eyes had peripheral vascular and optic disc leakage, respectively. The mean follow-up was 2.5 years and all patients required immunomodulatory treatment. CONCLUSIONS Middle Eastern patients with TINU seem to have a male predominance, a bimodal distribution in terms of age, and present with ocular involvement first. Multimodal imaging is paramount in detecting subclinical inflammation and tailoring immunomodulatory treatment.
Collapse
Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shaikha Aljeneibi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Nguyen NV, Oyeniran E, Zeleny A, Chen M, Sherif NA, Konstantinou E, Vitale S, Sen HN, Kodati S. Ultrawide-field fluorescein angiography features in patients with anterior uveitis. Eye (Lond) 2024; 38:1742-1747. [PMID: 38472380 PMCID: PMC11156897 DOI: 10.1038/s41433-024-03012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To evaluate the utility of ultrawide-field fluorescein angiography (UWFFA) in patients with anterior uveitis by investigating the detection of retinal vascular leakage (RVL) and the subsequent implications on disease diagnosis and management. STUDY DESIGN/MATERIALS AND METHODS Patients, who were referred to the National Eye Institute (NEI) for evaluation of anterior uveitis and underwent UWFFA imaging at the initial visit, were included in this study. The electronic medical records of eligible patients were reviewed. The UWFFA images were assessed for severity of retinal vascular leakage, presence of macular leakage, and optic disc leakage by a two-grader system, and intergrader agreement was calculated using the κ-value. Patients with altered diagnoses and management attributable to UWFFA results were noted. RESULTS A total of 93 eyes of 63 patients were included in the study. Of 93 eyes, 31 (33.3%) eyes had RVL on UWFFA, with 26 (28.0%) eyes and 5 (5.4%) eyes showing mild and moderate-severe RVL, respectively. Twenty-five (26.9%) eyes showed macular leakage, and 7 (7.5%) eyes showed optic disc leakage. The κ-values ranged from 0.85 - 0.87 indicating excellent intergrader agreement. Of the 31 eyes with RVL, the diagnosis was changed to anterior/intermediate uveitis for 9 (29.0%) eyes and to panuveitis for 4 (12.9%) eyes. Systemic treatment was escalated in 5 patients. CONCLUSION Our results suggest that UWFFA imaging is useful in detecting subclinical posterior involvement in patients with anterior uveitis. Moreover, UWFFA results in altered diagnosis and treatment approaches in a portion of patients.
Collapse
Affiliation(s)
- Nam V Nguyen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Enny Oyeniran
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander Zeleny
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Ophthalmology, George Washington School of Medicine, Washington, DC, USA
| | - Michelle Chen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- Howard University College of Medicine, Washington, DC, USA
| | - Noha A Sherif
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Eleni Konstantinou
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
4
|
Pleyer U, Pavesio C, Miserocchi E, Heinz C, Devonport H, Llorenç V, Burke T, Nogueira V, Kodjikian L, Bodaghi B. Fluocinolone acetonide 0.2 µg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations. J Ophthalmic Inflamm Infect 2024; 14:22. [PMID: 38814386 PMCID: PMC11139823 DOI: 10.1186/s12348-024-00402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants. METHODS A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS. RESULTS The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice. CONCLUSIONS As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes.
Collapse
Affiliation(s)
- Uwe Pleyer
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Carlos Pavesio
- Department of Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Elisabetta Miserocchi
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carsten Heinz
- Department of Ophthalmology at St, Franziskus Hospital Muenster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Helen Devonport
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - Víctor Llorenç
- Clínic Hospital of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Tomás Burke
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100, Villeurbanne, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
5
|
Yagci BA, Kaya M, Ayhan Z, Atas F, Yaman A, Saatci AO. Wide-Field Fluorescein Angiography in Patients with Idiopathic Acute Anterior Uveitis. Ocul Immunol Inflamm 2024; 32:281-286. [PMID: 36696573 DOI: 10.1080/09273948.2023.2168697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). METHODS The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. RESULTS Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5-18) years in the pediatric group and 42.36 ± 32.07 (range, 24-68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764). Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. CONCLUSION Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.
Collapse
Affiliation(s)
- Betul Akbulut Yagci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mahmut Kaya
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ferdane Atas
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
6
|
Shi J, Xu S, Chen J, Wu H. Clinical manifestations and outcomes in tubulointerstitial nephritis and uveitis syndrome: a case report and a systematic review in China. Int Urol Nephrol 2024; 56:1415-1427. [PMID: 37755610 PMCID: PMC10924013 DOI: 10.1007/s11255-023-03797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon disease. We present a confirmed case of TINU syndrome, and a systematic review of epidemiological characteristics, clinical manifestations, management, and outcomes in Chinese patients. METHODS A systematic search was carried out using defined terms and updated up to September 2022, in PubMed, Web of Science, Wanfang, CNKI, and VIP, to identify reported cases of TINU in China, according to PRISMA guidelines. RESULTS An 18-year-old boy presented with elevated serum creatinine and 24-h urine protein level of > 2 g. Inspection result revealed acute tubulointerstitial nephritis, and bilateral uveitis. The patient was diagnosed with TINU syndrome and received treatment with methylprednisolone sodium succinate, which resulted in a significant decrease in creatinine and urinary protein levels. Systematic review identified 35 publications that met the inclusion criteria. A total of 71 cases were included in this article, of which 70 were from publications and 1 was from our hospital. The median age at onset was 42 years and was significantly lower in males than females (P < 0.05). The symptoms of uveitis often occurred after kidney injury (54%) and most uveitis was anterior (55%) and bilateral (75%). Among the 51 patients who were followed up for more than 6 months, 24 had recurrent ocular symptoms or progression to chronic uveitis. Twenty patients experienced chronic or progressive kidney disease. CONCLUSION TINU syndrome is prone to misdiagnosis because kidney damage may not occur simultaneously with uveitis. The incidence of kidney sequelae in children is lower than that in adults, and glucocorticoids are the preferred treatment. INPLASY REGISTRATION NUMBER INPLASY202350050.
Collapse
Affiliation(s)
- Jiazhen Shi
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Shaoyan Xu
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jianxiang Chen
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China.
| | - Henglan Wu
- Department of Nephrology, The First Hospital of Jiaxing, First Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China.
| |
Collapse
|
7
|
Uludag Kirimli G, Hassan M, Onghanseng N, Or C, Yasar C, Park S, Akhavanrezayat A, Mobasserian A, Yavari N, Bazojoo V, Khojasteh H, Ghoraba H, Karaca I, Trong Tuong Than N, Zaidi M, Nguyen QD. Ocular manifestations and clinical outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). Eye (Lond) 2024; 38:349-356. [PMID: 37626158 PMCID: PMC10810898 DOI: 10.1038/s41433-023-02695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). METHODS The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed. RESULTS Twenty-six (26) eyes of 13 patients with TINU were reviewed in this study. The median age at onset of uveitis was 14 (range, 9-45). Eight (61.5%) subjects were female. The median follow-up of patients was 30 months (range, 6-89 months). Posterior segment findings were seen in 18 eyes of 9 patients (69.2%). The most common posterior findings were optic nerve head inflammation (16 eyes, 88.8%) and retinal vasculitis (13 eyes, 72.2%). Other posterior findings included vitritis (8 eyes, 44.4%), macular edema (6 eyes, 33.3%), snowball (4 eyes, 22.2%), and chorioretinal lesions (2 eye, 11.1%). Eight patients had fluorescein angiography (FA) data available and most eyes had retinal capillary leakage (13 eyes, 81.2%) followed by optic disc staining/leakage (12 eyes, 75%). Twelve (12) patients (92.3%) were treated with immunomodulatory treatment (IMT) and/or biologics. Five patients (%38.4) required biologics to control intraocular inflammation. CONCLUSION Posterior segment involvement may be common in patients with TINU syndrome. FA provides significant information for detecting posterior segment involvement and disease activity in TINU. The majority of patients required systemic treatment in order to control intraocular inflammation and prevent relapses.
Collapse
Affiliation(s)
- Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Hassan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Neil Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Chris Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sungwho Park
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hassan Khojasteh
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
| |
Collapse
|
8
|
Janetos TM, Lee PHA, Goldstein DA. Tubulointerstitial Nephritis and Uveitis Syndrome in Pediatric Patients. Ocul Immunol Inflamm 2023; 31:1955-1964. [PMID: 37983806 DOI: 10.1080/09273948.2023.2279689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a disorder that was originally described in 1975. The syndrome, although diagnosed in all age ranges, is more frequently reported in pediatric patients. Diagnosis can be difficult, and its clinical spectrum is still being defined. In this article, we review the epidemiology, diagnosis, pathogenesis, clinical findings, prognosis, and treatment of both the ocular and renal disease. We comment on the current difficulties in diagnosis and study of the disease, its expanding clinical spectrum, and treatment strategies in pediatric patients.
Collapse
Affiliation(s)
- Timothy M Janetos
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
9
|
Scifo L, Willermain F, Postelmans L, Pozdzik A, Lolin Sekelj K, Zampieri M, de Jong C, Makhoul D. Subclinical Choroidal Inflammation Revealed by Indocyanine Green Angiography in Tubulointerstitial Nephritis and Uveitis Syndrome. Ocul Immunol Inflamm 2022; 30:1190-1198. [PMID: 34191677 DOI: 10.1080/09273948.2020.1869267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe subclinical chorioretinal lesions revealed by indocyanine green angiography (ICGA) and their evolution under systemic treatment in tubulointerstitial nephritis and uveitis (TINU) patients. METHODS Retrospective case series of three patients with TINU syndrome. Choroidal and retinal involvement were assessed by fluorescein angiography (FA) and ICGA. RESULTS Three patients were analyzed. FA demonstrated hot disc, associated in two cases with retinal vascular leakage, and ICGA revealed subclinical chorioretinal dots in all three cases. Given the presence of posterior uveitis and deterioration of kidney function, asystemic treatment by oral methylprednisolone was started. Persistence of retinal and choroidal inflammations under systemic corticosteroids required association with immunosuppressive agent to control the disease activity. CONCLUSION Multimodal imaging and more precisely ICGA is useful to assess subclinical choroidal inflammation and monitor treatment response in TINU syndrome. Immunosuppression needs to be revised and adapted when uveitis and/or kidney function are unresponsive to systemic steroids. ABBREVIATIONS TINU: tubulointerstitial nephritis and uveitis; TIN: tubulointerstitial nephritis; ACE: angiotensin-converting enzyme; RF: rheumatoid factor; Uβ2M: urinary β-2microglobulin; AMPPE: acute multifocal placoid pigment epitheliopathy; FA: fluorescein angiography; ICGA: indocyanine green angiography; CT: computed tomography.
Collapse
Affiliation(s)
- Lisa Scifo
- Department of Ophthalmology, CHU St-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - François Willermain
- Department of Ophthalmology, CHU St-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Postelmans
- Department of Ophthalmology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnieszka Pozdzik
- Department of Nephrology and Dialysis, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Ksenija Lolin Sekelj
- Department of Pediatric Nephrology, Hôpital Universitaire des Enfants - Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Monalisa Zampieri
- Department of Pediatrics, CHU St-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Casper de Jong
- Department of Ophthalmology, Hôpital Universitaire des Enfants - Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Dorine Makhoul
- Department of Ophthalmology, CHU St-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
10
|
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
|
11
|
Petek T, Frelih M, Marčun Varda N. Tubulointerstitial nephritis and uveitis syndrome in an adolescent female: a case report. J Med Case Rep 2021; 15:443. [PMID: 34479628 PMCID: PMC8417986 DOI: 10.1186/s13256-021-03017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tubulointerstitial nephritis with uveitis syndrome is a rare disease affecting mainly children and young women. Tubulointerstitial nephritis with uveitis is a diagnosis of exclusion, requiring a high degree of clinical suspicion. Studies report recent infections or certain drugs as precipitating factors of a lymphocytic oculorenal immune response. The prognosis is usually favorable with topical and systemic corticosteroid therapy. CASE PRESENTATION We report a literature review and the case of a 14-year-old white girl, who presented to the ophthalmology department with features of one-sided uveitis. Upon transfer of patient to nephrological care, diagnostic work-up revealed renal involvement. Renal biopsy showed a mixed-cell and granulomatous tubulointerstitial nephritis with some noncaseating granulomas, leading to a diagnosis of tubulointerstitial nephritis with uveitis syndrome. With topical ocular and systemic corticosteroid therapy, the patients' condition improved over several weeks. CONCLUSIONS Our case highlights the importance of early recognition and treatment of this syndrome, where cross-specialty care typically leads to a favorable outcome.
Collapse
Affiliation(s)
- Tadej Petek
- Department of Pediatrics, University Medical Center Maribor, Ljubljanska ulica 5, Maribor, Slovenia.
| | - Maja Frelih
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, Ljubljana, Slovenia
| | - Nataša Marčun Varda
- Department of Pediatrics, University Medical Center Maribor, Ljubljanska ulica 5, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska ulica 8, Maribor, Slovenia
| |
Collapse
|
12
|
Kumar V, Surve A, Kumawat D, Takkar B, Azad S, Chawla R, Shroff D, Arora A, Singh R, Venkatesh P. Ultra-wide field retinal imaging: A wider clinical perspective. Indian J Ophthalmol 2021; 69:824-835. [PMID: 33727441 PMCID: PMC8012972 DOI: 10.4103/ijo.ijo_1403_20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 01/09/2023] Open
Abstract
The peripheral retina is affected in a variety of retinal disorders. Traditional fundus cameras capture only a part of the fundus even when montaging techniques are used. Ultra-wide field imaging enables us to delve into the retinal periphery in greater detail. It not only facilitates assessing color images of the fundus, but also fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and red and green free images. In this review, a literature search using the keywords "ultra-widefield imaging", "widefield imaging", and "peripheral retinal imaging" in English and non-English languages was done and the relevant articles were included. Ultra-wide field imaging has made new observations in the normal population as well as in eyes with retinal disorders including vascular diseases, degenerative diseases, uveitis, age-related macular degeneration, retinal and choroidal tumors and hereditary retinal dystrophies. This review aims to describe the utility of ultra-wide field imaging in various retinal disorders.
Collapse
|
13
|
Diala FGI, McCarthy K, Chen JL, Tsui E. Multimodal imaging in pediatric uveitis. Ther Adv Ophthalmol 2021; 13:25158414211059244. [PMID: 34901748 PMCID: PMC8655435 DOI: 10.1177/25158414211059244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric uveitis accounts for up to 10% of all uveitis cases, so special attention must be paid to ensure early diagnosis as well as treatment and follow-up of these young patients in order to decrease the risk of possible ocular complications and consequently vision loss. Multimodal imaging has been an effective and important adjunct in the diagnoses and management of uveitis, especially in children. Reviewed here are the currently utilized modalities, advances, as well as their applications in juvenile idiopathic arthritis-associated uveitis, pars planitis, retinal vasculitis, tubulointerstitial nephritis and uveitis syndrome, Behçet disease, Blau syndrome, and Vogt-Koyanagi-Harada syndrome.
Collapse
Affiliation(s)
- Fitz Gerald I. Diala
- UCLA Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kayne McCarthy
- John A. Burns School of Medicine, University of Hawai’i at Ma¯noa, Honolulu, HI, USA
| | - Judy L. Chen
- UCLA Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edmund Tsui
- UCLA Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, 200 Stein Plaza, Los Angeles, CA 90095-7003, USA
| |
Collapse
|
14
|
Koreishi AF, Zhou M, Goldstein DA. Tubulointerstitial Nephritis and Uveitis Syndrome: Characterization of Clinical Features. Ocul Immunol Inflamm 2020; 29:1312-1317. [DOI: 10.1080/09273948.2020.1736311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anjum F. Koreishi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mei Zhou
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Debra A. Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
15
|
Tekin K, Erol YO, Kurtulan O, Baydar DE. A case of adult-onset tubulointerstitial nephritis and uveitis syndrome presenting with granulomatous panuveitis. Taiwan J Ophthalmol 2020; 10:66-70. [PMID: 32309128 PMCID: PMC7158930 DOI: 10.4103/tjo.tjo_33_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/06/2018] [Indexed: 11/05/2022] Open
Abstract
The tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disorder that is probably underdiagnosed in clinical practice. Ocular involvement in TINU syndrome not only presents with the nongranulomatous anterior uveitis in 80% of patients but also manifests as intermediate, posterior, or panuveitis. This case report mentions an adult male patient who presented with granulomatous iridocyclitis with panuveitis and mild renal insufficiency. Workup for connective tissue and infectious diseases was negative for the patient. He was diagnosed with TINU syndrome based on the findings of renal biopsy. Both the uveitis and nephritis promptly responded well to steroid treatment, and there was no recurrence during the follow-up of 24 months.
Collapse
Affiliation(s)
- Kemal Tekin
- Department of Ophthalmology, Ercis State Hospital, Van, Turkey
| | - Yasemin Ozdamar Erol
- Department of Uveal Diseases, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Olcay Kurtulan
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
16
|
Cunningham ET, Munk MR, Kiss S, Zierhut M. Ultra-Wide-Field Imaging in Uveitis. Ocul Immunol Inflamm 2019; 27:345-348. [PMID: 31184555 DOI: 10.1080/09273948.2019.1605264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Marion R Munk
- d Department of Ophthalmology, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland.,e Bern Photographic Reading Center, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland
| | - Szilárd Kiss
- f Department of Ophthalmology , Weill Cornell Medical College , NY , USA
| | - Manfred Zierhut
- g Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
| |
Collapse
|