ESPN 50th Annual Meeting

ESPN 2017


 
TUBULOINTERSTITIAL NEPHRITIS WITH UVEITIS IN ELEVEN-YEAR-OLD PATIENT.
MARINA AKSENOVA 1 TATJANA KYRGANOVA 1 TATJANA LEPAEVA 1 NATALYA KONKOVA 1

1- SCIENTIFIC RESEARCH CLINICAL INSTITUTE OF PEDIATRICS, N.I.PIROGOV’ NATIONAL RUSSIAN MEDICAL UNIVERSITY OF MOSCOW
 
Introduction:

 Tubulointerstitial nephritis with uveitis syndrome (TINU) is a rare disorder. The etiology, therapy and outcome of patients with TINU remain unclear.

Material and methods:

 We review the clinical case of patient with TINU.

Results:

 An 11-year-old caucasian girl was admitted in hospital with a history of fever, extreme fatigue, weight loss (4 kg/month).At admission she had signs of renal insufficiency (serum creatinine 120 µmol/l, urea 11,6 mmol/l, eGFR 59 ml/min), anemia (hemoglobine 105 g/l), elevated erythrocyte sedimentation rate (65 mm/h) and C-reactive protein (2,5 mg/dl), urinalysis showed low urine density (1003-1005), normoglycemic glucosuria (11 mmol/l), proteinuria (0,27 g/d). ANF, anti-ds-DNA, LE cells, p-ANCA, c-ANCA, anti-cardiolipine-antibodies, PCR for EBV, HSV, CMV in serum, Mantoux test were negative. C3 and C4 serum levels, renal ultrasound, chest X-ray were normal. Diagnosis of acute interstitial nephritis was probable. One month after acute renal injuary the girl presented with recurrent bilateral non granulomatous anterior uveitis, she was treated with topical steroids. A renal biopsy was performed from 6 mo after disease onset because of persistent elevated serum creatinine (98-106 µmol/l) and β2-microglobulinuria (2,2 mg/l, N<0,3 mg/l). The biopsy showed significant dense lymphocytes, plasmocytes interstitial infiltration, tubulitis, secondary ischemic glomerular damages, immunofluorescence was negative. The clinical and morphological signs were consistent with TINU. Therapy with prednisone (1mg/kg/day for 3 months, gradual withdrawal over 3 months) led to remission of uveitis and normalization of serum creatinine (78 µmol/l), urinary β2-microglobuline (0,25 mg/l). To date the duration of remission of TINU is 12 months.

Conclusions:

TINU syndrome should be considered in case of “idiopathic” acute interstitial nephritis and in case of bilateral anterior uveitis. The renal biopsy results of our patient from 6 mo of disease onset could confirmed that TINU’s patients tend to have prolonged clinical course and may need long-term anti-inflammatory treatment. The urinary β2-microglobuline level may reflect the efficacy of therapy of TINU.