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Helms E, Servilla KS, Hartshorne MF, Harris A, Nichols MJ, Tzamaloukas AH. Tubulointerstitial nephritis and uveitis syndrome: use of gallium scintigraphy in its diagnosis and treatment. Int Urol Nephrol 2006; 37:119-22. [PMID: 16132773 DOI: 10.1007/s11255-004-2356-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prompt diagnosis and treatment with corticosteroids of the tubulointerstitial nephritis with uveitis (TINU) syndrome may assist in the preservation of renal function. We present a case illustrating the characteristic clinical features of this syndrome. Gallium scintigraphy assisted in the diagnosis and management of this case, which was complicated by relapsing pyelonephritis.
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Affiliation(s)
- Elizabeth Helms
- Medicine Service, Radiology Service, and Pathology Service, New Mexico Veterans Affairs Health Care System Renal Section (111C), University of New Mexico School of Medicine, 1501 San Pedro SE, Albuquerque, NM 87108, USA
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Abstract
The world's medical literature on tubulointerstitial nephritis and uveitis (TINU) syndrome was reviewed, and data on 133 patients with TINU syndrome were identified. The median age of onset was 15 years (range 9-74 years) with a 3:1 female-to-male predominance. Common laboratory abnormalities included elevated Westergren erythrocyte sedimentation rates and elevated urinary beta-2-microglobulin levels. Ocular symptoms preceded systemic symptoms in 21% of cases, and followed systemic symptoms by up to 14 months in 65% of cases. Uveitis involved only the anterior segment in 80% of cases. Uveitis was bilateral at presentation in 77% of cases. Patients were treated with systemic corticosteroids in 80% of cases and with immunosuppressive drugs in 9% of cases. Uveitis recurred or followed a chronic course in 56% of patients and persisted for several years in some cases. Ocular complications (including posterior synechiae, cataracts, and elevated intraocular pressure) were reported in 21% of cases. The visual prognosis appears to be good. Persistent renal dysfunction was reported in 11% of cases, including five patients who required renal dialysis. TINU syndrome is a distinct clinical entity that may be under-recognized and may account for some cases of unexplained chronic or recurrent uveitis. It is important for ophthalmologists, nephrologists, and primary care providers to be familiar with this disorder to ensure early diagnosis and appropriate treatment.
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Affiliation(s)
- J T Mandeville
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, Los, Angeles, CA 90095-7003, USA
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Paul E, Van Why S, Carpenter TO. Hyperthyroidism: a novel feature of the tubulointerstitial nephritis and uveitis syndrome. Pediatrics 1999; 104:314-7. [PMID: 10429017 DOI: 10.1542/peds.104.2.314] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tubulointerstitial nephritis and uveitis syndrome presents with either renal or ocular manifestations, and associated weight loss. We report two adolescents with transient hyperthyroidism early in the course of the syndrome. Hyperthyroidism may represent an unrecognized feature of the disorder and potentially contributes to the accompanying weight loss. Thyroid function should be evaluated in patients with tubulointerstitial nephritis and uveitis syndrome and symptomatic therapy provided when necessary.
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Affiliation(s)
- E Paul
- Yale University School of Medicine, New Haven, CT 06520-8064, USA
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Birnbacher R, Balzar E, Aufricht C, Schmaldienst S, Woloszczuk W, Förster E. Tubulointerstitial nephritis and uveitis: an immunological disorder? Pediatr Nephrol 1995; 9:193-5. [PMID: 7794717 DOI: 10.1007/bf00860744] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 14-year-old boy with tubulointerstitial nephritis and uveitis (TINU syndrome) is described. Nephropathy improved without systemic cortisone treatment, whereas uveitis relapsed and was treated with topical steroids. Blood cell immunological analysis and serum analysis revealed signs of cytotoxic T-cell, macrophage and granulocyte activation, which declined as the clinical symptoms improved. This may be interpreted as an indication of their significance as markers in the pathogenesis of this syndrome or as part of a microbial-triggered immune response.
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Affiliation(s)
- R Birnbacher
- Department of Paediatrics, University of Vienna, Austria
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Abstract
A syndrome of acute interstitial nephritis (AIN) and anterior uveitis is described in two children and the literature is reviewed. These disorders appear to improve, in uncontrolled studies, with systemic and topical ophthalmic corticosteroid treatment. Although the renal and ocular prognoses appear good, it is important to recognize that patients with AIN are at risk for uveitis and if present, consultation with an ophthalmologist is recommended.
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Affiliation(s)
- T E Bunchman
- Division of Pediatric Nephrology, University of Michigan, Ann Arbor
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Murray N, Wakefield D. Primary tubulointerstitial nephritis and uveitis syndrome. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1993; 21:121-2. [PMID: 8333934 DOI: 10.1111/j.1442-9071.1993.tb00765.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Primary acute tubulointerstitial nephritis and uveitis is an uncommon syndrome involving the kidney and eye. Although rare, to date 28 cases having been reported, it is important to recognise this entity to facilitate appropriate investigation and treatment. We report an unusual case of this syndrome in which the patient suffered a relapse of her nephritis concurrently with the onset of the first episode of uveitis. Both responded to treatment, although the uveitis subsequently recurred.
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Affiliation(s)
- N Murray
- Laboratory of Ocular Immunology, School of Pathology, University of New South Wales, Woolloomooloo
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Igarashi T, Kawato H, Kamoshita S, Nosaka K, Seiya K, Hayakawa H. Acute tubulointerstitial nephritis with uveitis syndrome presenting as multiple tubular dysfunction including Fanconi's syndrome. Pediatr Nephrol 1992; 6:547-9. [PMID: 1482643 DOI: 10.1007/bf00866499] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe an 11-year-old male patient with acute tubulointerstitial nephritis with uveitis (TINU) syndrome. He presented with easy fatigability, pallor, nocturia and weight loss. Laboratory examination disclosed anaemia, polyclonal hypergammaglobulinaemia, low molecular weight proteinuria, glycosuria, aminoaciduria, proximal and distal renal tubular acidosis, a urine concentration defect and decreased creatinine clearance. The multiple renal tubular dysfunction and slight glomerular dysfunction subsided spontaneously. Bilateral anterior uveitis was manifested 7 months after the onset of the disease. This is the first reported case of TINU syndrome with multiple proximal and distal tubular dysfunction including a complete type of Fanconi's syndrome.
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Affiliation(s)
- T Igarashi
- Department of Paediatrics, Faculty of Medicine, University of Tokyo, Japan
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Montagnon F, Frésard A, Prallet B, Diab N, Alexandre C. Néphrite interstitielle aiguë avec uvéite. A propos d'un cas. Rev Med Interne 1992; 13:384-6. [PMID: 1344838 DOI: 10.1016/s0248-8663(05)81207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dobrin et al described in 1975 the first case report with acute renal failure due to tubulo-interstitial nephritis accompanied by uveitis and an inflammatory syndrome. The young adults are frequently involved and the complete resolution is usually obtained after corticosteroid treatment; this contrasts with the tendency towards relapse of the uveitis. The etiology and the pathogenesis of this syndrome remain unknown. We report the case of a woman which the renal function was incompletely reversible with corticosteroids.
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Affiliation(s)
- F Montagnon
- Service de Rhumatologie, Hôpital Bellevue, Saint-Etienne
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Affiliation(s)
- C B Wilson
- Research Institute of Scripps Clinic, La Jolla, California
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Stupp R, Mihatsch MJ, Matter L, Streuli RA. Acute tubulo-interstitial nephritis with uveitis (TINU syndrome) in a patient with serologic evidence for Chlamydia infection. KLINISCHE WOCHENSCHRIFT 1990; 68:971-5. [PMID: 2232628 DOI: 10.1007/bf01646656] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 38-year-old female patient with acute tubulo-interstitial nephritis and uveitis (TINU syndrome) is described. The cause of this rare disease is unknown; most patients affected are adolescent females. Serologic investigations in the patient reported point to a possible etiologic role of Chlamydia infection in this disease.
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Affiliation(s)
- R Stupp
- Medizinische Klinik, Regionalspital Langenthal, Schweiz
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Catalano C, Harris PE, Enia G, Postorino M, Martorano C, Maggiore Q. Acute interstitial nephritis associated with uveitis and primary hypoparathyroidism. Am J Kidney Dis 1989; 14:317-8. [PMID: 2801703 DOI: 10.1016/s0272-6386(89)80212-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a study of a patient with acute renal failure and uveitis, renal biopsy showed acute interstitial nephritis. Serum calcium and parathyroid hormone concentrations were persistently low during the acute phase and after the resolution of renal failure. Clinical history was negative for intake of drugs capable of inducing acute interstitial nephritis.
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Affiliation(s)
- C Catalano
- Centro di Fisiologia Clinica del Consiglio Nazionale delle Ricerche, Reggio Calabria, Italy
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Wilson CB. Study of the immunopathogenesis of tubulointerstitial nephritis using model systems. Kidney Int 1989; 35:938-53. [PMID: 2651771 DOI: 10.1038/ki.1989.78] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C B Wilson
- Department of Immunology, Research Institute of Scripps Clinic, La Jolla, California
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Ten RM, Torres VE, Milliner DS, Schwab TR, Holley KE, Gleich GJ. Acute interstitial nephritis: immunologic and clinical aspects. Mayo Clin Proc 1988; 63:921-30. [PMID: 3045437 DOI: 10.1016/s0025-6196(12)62697-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute interstitial nephritis is a common renal syndrome that may be associated with a variety of infections and drug therapies or may develop without an identified cause. Three cases are presented to illustrate the three types of acute interstitial nephritis--drug related, infection related, and idiopathic. Cell-mediated immune mechanisms seem to be more important than humorally mediated mechanisms in the pathogenesis of acute interstitial nephritis. Frequently, eosinophils are identified as a component of the interstitial cellular infiltrate, and eosinophiluria and eosinophilia have been claimed to be helpful in the diagnosis of acute interstitial nephritis, especially the drug-induced type. Neither eosinophiluria nor the presence of increased urinary levels of eosinophil major basic protein, however, is specific for the diagnosis of acute interstitial nephritis. Patients with drug-induced interstitial nephritis frequently have symptoms and signs suggestive of a hypersensitivity syndrome and rarely have more dramatic anaphylactic manifestations. Systemic glucocorticoids have been shown to be beneficial in this type of acute interstitial nephritis.
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Affiliation(s)
- R M Ten
- Allergic Diseases Research Laboratory, Mayo Clinic, Rochester, MN 55905
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Abstract
Five patients had bilateral anterior uveitis associated with renal disease. Interstitial nephritis was histologically confirmed in three cases. Fatigue, anorexia, abdominal pain, weight loss, and anemia were common systemic complaints or findings. In each case, the uveitis was anterior, eventually bilateral, and associated with minimal visual impairment. Complications of the uveitis included increased intraocular pressure, synechiae, keratic precipitates, macular edema, and intraretinal hemorrhage as well as cells in the anterior vitreous humor and an exudate over the pars plana. Sjögren's syndrome, systemic lupus erythematosus, sarcoid, and syphilis were excluded as diagnoses that could explain the association of renal and uveal disease.
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Affiliation(s)
- J T Rosenbaum
- Department of Medicine, Oregon Health Sciences University, Portland 97201
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Spital A, Panner BJ, Sterns RH. Acute idiopathic tubulointerstitial nephritis: report of two cases and review of the literature. Am J Kidney Dis 1987; 9:71-8. [PMID: 3544825 DOI: 10.1016/s0272-6386(87)80165-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two patients who presented with severe renal failure and evidence of generalized proximal tubular dysfunction were found to have severe diffuse acute tubulointerstitial nephritis on renal biopsy. No etiology could be found in either case. Both patients had dramatic improvement in renal function following steroid therapy. In the first reported case of its kind, one patient relapsed when steroids were withdrawn, but improved again with reinstitution of steroid therapy. These cases, as well as others in the literature, show that steroids are effective and may be necessary to improve renal function in some patients with acute idiopathic tubulointerstitial nephritis. Evidence of proximal tubular dysfunction is a clue to the presence of this disorder.
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