Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome

From EyeWiki
Original article contributed by: Kendra Denise Clemons, MD
All contributors: Robert H. Janigian, Jr. M.D.
Assigned editor:
Review: Assigned status Update Pending by Robert H. Janigian, Jr. M.D. on May 17, 2015.



Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome
Classification and external resources
OMIM 607665


Disease Entity

Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon oculorenal disorder. Uveitis occurring in association with TINU was first described in 1975 by Dobrin et al.

Disease

It occurs mostly in adolescence with a median age of 15. It was initially thought to be more common in females with a 3:1 female-to-male preponderance but a recent study showed a higher prevelance in males.

Etiology

It is thought to be an immune-mediated process that can be drug-related, infection-related, or idiopathic and can account for 10-15% of patients with acute renal failure.

General Pathology

Renal Biopsy: eosinophilic and mononuclear cellular infiltrates with glomerular sparing

Diagnosis

Diagnosis is made by a combination of clinical presentation, clinical ocular findings and laboratory results.

History

Systemic symptoms include fever, weight loss, myalgia, arthralgia, rash. Ocular symptoms include blurriness, redness, pain.

Physical examination

The most common ocular findings include: anterior chamber cell/flare, conjunctival injection, and keratic precipitates.

Signs

Acute Non-granulomatous anterior uveitis

Diagnostic procedures

Possible renal biopsy

Laboratory test

Abnormal serum creatinine level or decreased creatinine clearance, urinalysis with increased β2 microglobulin, proteinuria, presence of eosinophils, pyuria or hematuria, urinary white cells casts, and normoglycemic glucosuria.

Differential diagnosis

Other causes of acute anterior uveitis including: HLA B27 related entities, infectious causes such as syphilis and herpes, juvenile idiopathic arthritis, sarcoidosis, idiopathic. Masquerade syndromes such as leukemia and Juvenile Xanthrogranuloma should also be considered.

Management

Anterior uveitis can be treated with topical corticosteroids and cycloplegic agents as well as local periocular steroid injections as necessary. TINU syndrome is also very responsive to high-dose oral corticosteroids.

General treatment

Should be followed/co-managed with pediatrician, internist, nephrology consultant as the case may be.

Complications

As with all forms of uveitis cataract, glaucoma and cystoid macular edema can complicate inflammatory ocular disease.

Prognosis

Generally good as the condition responds well to corticosteroids.

Additional Resources

References

1. Kanski JJ, Bowling B. Clinical Ophthalmology: A Systemic Approach. 7th Ed. 2011. Elsevier Limited. Chapter 11:401-474.

2. Mackensen F, Smith JR, Rosenbaum JT. Enhanced Recognition, Treatment, and Prognosis of Tubulointerstitial Nephritis and Uveitis Syndrome. Ophthalmology. 2007; 114: 995-999.

3. Mandeville JTH, Levinson RD, Holland GN. The Tubulointerstitial Nephritis and Uveitis Syndrome. 2001. Surv Ophthalmol. 46:195-208

4. Murray PI, et al. Albert & Jakoblec’s Principles & Practice of Ophthalmology. 3rd Ed. 2000. W.B. Saunders Company. Elsevier, Inc. Chapter 92: 1137-1150.

5. Skuta GL, et al. Basic and Clinical Science Course: Section 9. 2013-2014. American Academy of Ophthalmology.