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Beitragstitel Adult onset tubulointerstitial nephritis and uveitis syndrome: an underdiagnosed disease?
Autor:innen
  1. Celine N. Haeller HFR - hôpital fribourgeois Präsentierende:r
Präsentationsform ePoster
Themengebiete
  • Uveitis / Intraocular Inflammation
Abstract-Text Purpose
We report one case of tubulointerstitial nephritis and uveitis syndrome (TINU) in an adult.
Method
A woman of 39 years old presented to Jules Gonin Eye Hospital, for a blurry vision with red eye, pain, photophobia and tearing of the left eye (OS). Clinical examination as well as etiological blood test were performed.
Results
Clinical examination showed a normal visual acuity and intraocular pressure both sides (OU). The biomicroscopic examination highlighted a first episode of non-granulomatous acute anterior uveitis in OS. Topical treatments of Prednisolone 1% q.h., Scopolamine 0,25% t.i.d. and Ultracortenol ointment nocte were introduced. Because of a bilateralization of the uveitis in the follow-up, an etiological blood test was performed. The latter showed an acute renal failure, with a creatinine of 142 µmol/l, corresponding to an eGFR (CKD-EPI) of 40 ml/min/1.73m2, together with an elevated ß2-microglobuline (5.02 mg/l). Urinalysis results were unremarkable and her kidneys appeared normal by sonography. The patient then underwent a renal biopsy which showed a mononuclear tubulo-interstitial nephritis compatible with a TINU syndrome. A treatment with Prednisone 60mg was started and improved renal function and ocular outcome.
Discussion
TINU is a rare entity of unknown etiology, with a female and pediatric predominance, and only few cases are reported in adult population. The renal and ocular involvement is frequently asynchronous. At the time of diagnosis, a concomitant involvement is present in 15% of cases and may explain why TINU is probably underdiagnosed.
Uveitis in TINU syndrome is typically sudden, anterior and bilateral. Recurrence of uveitis is common.
A work-up, including a renal biopsy, is required to confirm the diagnosis of a tubulointerstitial nephritis in TINU syndrome and rule out other causes of acute renal failure.
Conclusion
TINU should be considered in the etiology of acute bilateral non-granulomatous uveitis in children, but also in adult. We therefore recommend to include in this situation, a renal function test in the work-up.