ESPN 50th Annual Meeting

ESPN 2017


 
TINU SYNDROME - CASE REPORT
SYLVA SKALOVA 1 KATERINA RACICKA 1 MARKETA MACHACKOVA 2 EVA HOVORKOVA 3 MIROSLAV PODHOLA 3

1- DEPARTMENT OF PAEDIATRICS , FACULTY OF MEDICINE AND UNIVERSITY HOSPITAL IN HRADEC KRALOVE, CHARLES UNIVERSITY, CZECH REPUBLIC
2- DEPARTMENT OF OPHTHALMOLOGY, FACULTY OF MEDICINE AND UNIVERSITY HOSPITAL IN HRADEC KRALOVE, CHARLES UNIVERSITY, CZECH REPUBLIC
3- THE FINGERLAND DEPARTMENT OF PATHOLOGY, FACULTY OF MEDICINE AND UNIVERSITY HOSPITAL IN HRADEC KRALOVE, CHARLES UNIVERSITY, CZECH REPUBLIC
 
Introduction:

Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare disorder occuring in less than 2% of cases of uveitis. Diagnosis requires the presence of both  TIN and uveitis. The most common signs and symptoms of uveitis include  photophobia,  eye pain and redness, eyelid edema and progressive loss of vision. Renal impairment is characterized by abnormal  renal function and abnormal urinalysis, symptoms of systemic illness, including fever, fatigue and weight loss. 

 

Material and methods:

Case report

14 -year old boy treated for acute anterior uveitis  was admitted to our department  because of increased serum creatinine  level.  On admission, physical examination was normal and uveitis  was in remission with only persistence of mild  visual impairment of the  right eye. He had no other clinical symptoms  except of  polyuria  (4000 ml /day) and associated polydipsia. 

 

Results:

Laboratory tests confirmed increased serum creatinine (189 µmol/L),  other biochemical parameters were within normal  reference range.  Urinalysis showed normoglycemic glycosuria, non-nephrotic glomerulo-tubular  proteinuria  and high levels of     β-2 microglobulin. Renal biopsy was consistent with tubulointerstitial nephritis, with  chronic inflammatory changes and tubular atrophy.  To complete the diagnostic work-up of TINU, we excluded infection, systemic and autoimmune causes. Because of persistent  impairment of renal function we decided to use oral corticosteroids,  which resulted in renal function improvement. However, after tapering of corticosteroids  the boy had recurrence of  uveitis and nephritis with decreased renal function. Treatment with topic and oral corticosteroids  led to uveitis control, but renal functions  remain impaired.  

 

Conclusions:

TINU syndrome is probably an underdiagnosed disorder  and must be actively searched in either patients with uveitis  or tubulointerstitial nephritis.  Symptoms  of uveitis and nephritis are not always present at the same time. Tubulointerstitial nephritis in our patient very probably  preceded  the manifestation of uveitis by several months.