Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome
|Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome|
|Classification and external resources|
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.
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.
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.
Renal Biopsy: eosinophilic and mononuclear cellular infiltrates with glomerular sparing
Diagnosis is made by a combination of clinical presentation, clinical ocular findings and laboratory results.
Systemic symptoms include fever, weight loss, myalgia, arthralgia, rash. Ocular symptoms include blurriness, redness, pain.
The most common ocular findings include: anterior chamber cell/flare, conjunctival injection, and keratic precipitates.
Acute Non-granulomatous anterior uveitis
Possible renal biopsy
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.
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.
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.
Should be followed/co-managed with pediatrician, internist, nephrology consultant as the case may be.
As with all forms of uveitis cataract, glaucoma and cystoid macular edema can complicate inflammatory ocular disease.
Generally good as the condition responds well to corticosteroids.
- American Academy of Ophthalmology. Uveitis: Tubulointerstitial nephritis and uveitis (TINU) syndrome Practicing Ophthalmologists Learning System, 2017 - 2019 San Francisco: American Academy of Ophthalmology, 2017.
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