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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2021

Open Access 01-12-2021 | Uveitis | Case report

Tubulointerstitial nephritis and uveitis syndrome in an adolescent female: a case report

Authors: Tadej Petek, Maja Frelih, Nataša Marčun Varda

Published in: Journal of Medical Case Reports | Issue 1/2021

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Abstract

Background

Tubulointerstitial nephritis with uveitis syndrome is a rare disease affecting mainly children and young women. Tubulointerstitial nephritis with uveitis is a diagnosis of exclusion, requiring a high degree of clinical suspicion. Studies report recent infections or certain drugs as precipitating factors of a lymphocytic oculorenal immune response. The prognosis is usually favorable with topical and systemic corticosteroid therapy.

Case presentation

We report a literature review and the case of a 14-year-old white girl, who presented to the ophthalmology department with features of one-sided uveitis. Upon transfer of patient to nephrological care, diagnostic work-up revealed renal involvement. Renal biopsy showed a mixed-cell and granulomatous tubulointerstitial nephritis with some noncaseating granulomas, leading to a diagnosis of tubulointerstitial nephritis with uveitis syndrome. With topical ocular and systemic corticosteroid therapy, the patients’ condition improved over several weeks.

Conclusions

Our case highlights the importance of early recognition and treatment of this syndrome, where cross-specialty care typically leads to a favorable outcome.
Literature
1.
Dobrin RS, Vernier RL, Fish AJ. Acute eosinophilic interstitial nephritis and renal failure with bone marrow-lymph node granulomas and anterior uveitis. Am J Med. 1975;59(3):325–33.PubMedCrossRef
2.
Saarela V, Nuutinen M, Ala-Houhala M, Arikoski P, Rönnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476–81.PubMedCrossRef
3.
Mandeville JT, Levinson RD, Holland GN. The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol. 2001;46(3):195–208.PubMedCrossRef
4.
Tan Y, Yu F, Qu Z, Su T, Xing GQ, Wu LH, et al. Modified C-reactive protein might be a target autoantigen of TINU syndrome. Clin J Am Soc Nephrol. 2011;6(1):93–100.PubMedPubMedCentralCrossRef
5.
Kase S, Kitaichi N, Namba K, Miyazaki A, Yoshida K, Ishikura K, et al. Elevation of serum Krebs von den Lunge-6 levels in patients with tubulointerstitial nephritis and uveitis syndrome. Am J Kidney Dis. 2006;48(6):935–41.PubMedCrossRef
6.
Rytkönen S, Ritari J, Peräsaari J, Saarela V, Nuutinen M, Jahnukainen T. IL-10 polymorphisms +434T/C, +504G/T, and -2849C/T may predispose to tubulointerstitial nephritis and uveitis in pediatric population. PLoS ONE. 2019;14(2):0211915.CrossRef
7.
Kobayashi Y, Honda M, Yoshikawa N, Ito H. Acute tubulointerstitial nephritis in 21 Japanese children. Clin Nephrol. 2000;54(3):191–7.PubMed
8.
Howell M, Sebire NJ, Marks SD, Tullus K. Biopsy-proven paediatric tubulointerstitial nephritis. Pediatr Nephrol. 2016;31(10):1625–30.PubMedCrossRef
9.
Clive DM, Vanguri VK. The syndrome of tubulointerstitial nephritis with uveitis (TINU). Am J Kidney Dis. 2018;72(1):118–28.PubMedCrossRef
10.
11.
Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017;32(4):577–87.PubMedCrossRef
12.
Jones NP. The Manchester Uveitis Clinic: the first 3000 patients—epidemiology and casemix. Ocul Immunol Inflamm. 2015;23(2):118–26.PubMedCrossRef
13.
Amaro D, Carreño E, Steeples LR, Oliveira-Ramos F, Marques-Neves C, Leal I. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review. Br J Ophthalmol. 2019;4:1–7.
14.
Okafor LO, Hewins P, Murray PI, Denniston AK. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a systematic review of its epidemiology, demographics and risk factors. Orphanet J Rare Dis. 2017;12(1):1–9.CrossRef
15.
Pinheiro MA, Rocha MBC, Neri BO, Parahyba IO, Moura LAR, de Oliveira CMC, et al. TINU syndrome: review of the literature and case report. J Bras Nefrol. 2016;38(1):132–6.PubMedCrossRef
16.
17.
Gorrono-Echebarria MB, Calvo-Arrabal MA, Albarran F, Alvarez-Mon M. The tubulointerstitial nephritis and uveitis (TINU) syndrome is associated with HLA-DR14 in Spanish patients. Br J Ophthalmol. 2001;85:1010–1.PubMedCrossRef
18.
Peräsaari J, Saarela V, Nikkilä J, Ala-Houhala M, Arikoski P, Kataja J, et al. HLA associations with tubulointerstitial nephritis with or without uveitis in Finnish pediatric population: a nation-wide study. Tissue Antigens. 2013;81(6):435–41.PubMedCrossRef
19.
Levinson RD, Park MS, Rikkers SM, Reed EF, Smith JR, Martin TM, et al. Strong associations between specific HLA-DQ and HLA-DR alleles and the tubulointerstitial nephritis and uveitis syndrome. Investig Ophthalmol Vis Sci. 2003;44(2):653–7.CrossRef
20.
Mackensen F, David F, Schwenger V, Smith LK, Rajalingam R, Levinson RD, et al. HLA-DRB1*0102 is associated with TINU syndrome and bilateral, sudden-onset anterior uveitis but not with interstitial nephritis alone. Br J Ophthalmol. 2011;95(7):971–5.PubMedCrossRef
21.
Reddy AK, Hwang YS, Mandelcorn ED, Davis JL. HLA-DR, DQ class II DNA typing in pediatric panuveitis and tubulointerstitial nephritis and uveitis. Am J Ophthalmol. 2014;157(3):678-686.e2.PubMedCrossRef
22.
Jia Y, Su T, Gu Y, Li C, Zhou X, Su J, et al. HLA-DQA1, -DQB1, and -DRB1 alleles associated with acute tubulointerstitial nephritis in a Chinese population: a single-center cohort study. J Immunol. 2018;201(2):423–31.PubMedPubMedCentralCrossRef
23.
Vô B, Yombi JC, Aydin S, Demoulin N, Yildiz H. TINU-associated Fanconi syndrome: a case report and review of literature. BMC Nephrol. 2018;19(1):1–6.CrossRef
24.
25.
Clavé S, Rousset-Rouviere C, Daniel L, Tsimaratos M. Acute tubulointerstitial nephritis in children and chronic kidney disease. Arch Pediatr. 2019;26(5):290–4.PubMedCrossRef
26.
Lusco MA, Fogo AB, Najafian B, Alpers CE. AJKD atlas of renal pathology: tubulointerstitial nephritis with uveitis. Am J Kidney Dis. 2017;69(6):e27–8.PubMedCrossRef
27.
Carvalho TJ, Calça R, Cassis J, Mendes A. Tubulointerstitial nephritis and uveitis syndrome in a female adult. BMJ Case Rep. 2019;12(1).
28.
Sobolewska B, Bayyoud T, Deuter C, Doycheva D, Zierhut M. Long-term follow-up of patients with tubulointerstitial nephritis and uveitis (TINU) syndrome. Ocul Immunol Inflamm. 2016;26(4):1–7.CrossRef
29.
Baker RJ, Pusey CD. The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant. 2004;19(1):8–11.PubMedCrossRef
30.
Yang M, Chi Y, Guo C, Huang J, Yang L, Yang L. Clinical profile, ultra-wide-field fluorescence angiography findings, and long-term prognosis of uveitis in tubulointerstitial nephritis and uveitis syndrome at one tertiary medical institute in China. Ocul Immunol Inflamm. 2019;27(3):371–9.PubMedCrossRef
31.
Tanaka H, Suzuki K, Nakahata T, Tateyama T, Waga S, Ito E. Repeat renal biopsy in tubulointerstitial nephritis and uveitis syndrome: report of a case. Jpn J Nephrol. 2001;16:885–7.
32.
Yanagihara T, Kitamura H, Aki K, Kuroda N, Fukunaga Y. Serial renal biopsies in three girls with tubulointerstitial nephritis and uveitis syndrome. Pediatr Nephrol. 2009;24(6):1159–64.PubMedCrossRef
33.
Suzuki K, Tanaka H, Ito E, Waga S. Repeat renal biopsy in children with severe idiopathic tubulointerstitial nephritis. Pediatr Nephrol. 2004;19(2):240–3.PubMedCrossRef
34.
Weinstein O, Tovbin D, Rogachev B, Basok A, Vorobiov M, Kratz A, et al. Clinical manifestations of adult tubulointerstitial nephritis and uveitis (TINU) syndrome. Int Ophthalmol. 2010;30(5):621–8.PubMedCrossRef
35.
Biester S, Müller C, Deuter CME, Doycheva D, Altpeter E, Zierhut M. Tubulointerstitial nephritis and uveitis in siblings. Ocul Immunol Inflamm. 2010;18(5):370–2.PubMedCrossRef
36.
Houghton D, Troxell M, Fox E, Rosenbaum J. TINU (tubulointerstitial nephritis and uveitis) syndrome is not usually associated with IgG4 sclerosing disease. Am J Kidney Dis. 2012;59(4):583–4.PubMedCrossRef
37.
Birnbaum AD, Jiang Y, Vasaiwala R, Tessler HH, Goldstein DA. Bilateral simultaneous-onset nongranulomatous acute anterior uveitis. Arch Ophthalmol. 2012;130(11):1389.PubMedCrossRef
38.
Takemoto Y, Namba K, Mizuuchi K, Ohno S, Ishida S. Two cases of subfoveal choroidal neovascularization with tubulointerstitial nephritis and uveitis syndrome. Eur J Ophthalmol. 2013;23(2):255–7.PubMedCrossRef
39.
Li C, Su T, Chu R, Li X, Yang L. Tubulointerstitial nephritis with uveitis in Chinese adults. Clin J Am Soc Nephrol. 2014;9(1):21–8.PubMedCrossRef
40.
Ali A, Rosenbaum JT. TINU (tubulointerstitial nephritis uveitis) can be associated with chorioretinal scars. Ocul Immunol Inflamm. 2014;22(3):213–7.PubMedCrossRef
41.
Hettinga YM, Scheerlinck LME, Lilien MR, Rothova A, De Boer JH. The value of measuring urinary β2-microglobulin and serum creatinine for detecting tubulointerstitial nephritis and uveitis syndrome in young patients with uveitis. JAMA Ophthalmol. 2015;133(2):140–5.PubMedCrossRef
42.
Legendre M, Devilliers H, Perard L, Groh M, Nefti H, Dussol B, et al. Clinicopathologic characteristics, treatment, and outcomes of tubulointerstitial nephritis and uveitis syndrome in adults. Medicine (United States). 2016;95(26):1–9.
43.
Sawai T, Shimizu M, Sakai T, Yachie A. Tubulointerstitial nephritis and uveitis syndrome associated with human papillomavirus vaccine. J Pediatr Ophthalmol Strabismus. 2016;53(3):190–1.PubMedCrossRef
44.
Ariba YB, Labidi J, Elloumi Z, Selmi Y, Othmani S. Acute tubulointerstitial nephritis and uveitis syndrome: a report on four adult cases. Saudi J Kidney Dis Transpl. 2017;28(1):162–6.PubMedCrossRef
45.
Nagashima T, Ishihara M, Shibuya E, Nakamura S, Mizuki N. Three cases of tubulointerstitial nephritis and uveitis syndrome with different clinical manifestations. Int Ophthalmol. 2017;37(3):753–9.PubMedCrossRef
46.
Provencher LM, Fairbanks AM, Abramoff MD, Syed NA. Urinary β2-microglobulin and disease activity in patients with tubulointerstitial nephritis and uveitis syndrome. J Ophthalmic Inflamm Infect. 2018;8(1).
47.
Kanno H, Ishida K, Yamada W, Shiraki I, Murase H, Yamagishi Y, et al. Clinical and genetic features of tubulointerstitial nephritis and uveitis syndrome with long-term follow-up. J Ophthalmol. 2018;2018:1–8.CrossRef
48.
Zhang H, Wang F, Xiao H, Yao Y. The ratio of urinary α1-microglobulin to microalbumin can be used as a diagnostic criterion for tubuloproteinuria. Intractable Rare Dis Res. 2018;7(1):46–50.PubMedPubMedCentralCrossRef
49.
Pereira C, Gil J, Leal I, Costa-Reis P, Da SJEE, Stone R. Tubulointerstitial nephritis and uveitis syndrome in children: report of three cases. J Bras Nefrol. 2018;40(3):296–300.PubMedPubMedCentralCrossRef
50.
Takeuchi M, Kanda T, Kaburaki T, Tanaka R, Namba K, Kamoi K, et al. Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan: a multicenter study. Medicine (Baltimore). 2019;98(9):14668.CrossRef
51.
Abd El Latif E, Abdelhalim AS, Montasser AS, Said MH, Shikhoun Ahmed M, Abdel Kader Fouly Galal M, et al. Pattern of intermediate uveitis in an Egyptian cohort. Ocul Immunol Inflamm. 2020;28(3):524–31.PubMedCrossRef
52.
Çakan M, Yildiz Ekıncı D, Gül Karadağ S, Aktay AN. Etiologic spectrum and follow-up results of noninfectious uveitis in children: a single referral center experience. Arch Rheumatol. 2019;34(3):294–300.PubMedPubMedCentralCrossRef
53.
Cao JL, Srivastava SK, Venkat A, Lowder CY, Sharma S. Ultra-widefield fluorescein angiography and OCT findings in tubulointerstitial nephritis and uveitis syndrome. Ophthalmol Retin. 2020;4(2):189–97.CrossRef
54.
Roy S, Awogbemi T, Holt RCL. Acute tubulointerstitial nephritis in children—a retrospective case series in a UK tertiary paediatric centre. BMC Nephrol. 2020;21(1):17.PubMedPubMedCentralCrossRef
55.
Kitano M, Tanaka R, Kaburaki T, Nakahara H, Shirahama S, Suzuki T, et al. Clinical features and visual outcome of uveitis in Japanese patients younger than 18 years. Ocul Immunol Inflamm. 2020;1–7.
56.
Azar R, Verove C, Boldron A. Delayed onset of uveitis in TINU syndrome. J Nephrol. 2000;13(5):381–3.PubMed
57.
Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. 2007;114(5).
58.
Nikolić V, Bogdanović R, Ognjanović M, Stajić N. Acute tubulointerstitial nephritis in children. Srp Arh Celok Lek. 2001;129(Suppl):23–7.PubMed
59.
Sanchez-Burson J, Garcia-Porrua C, Montero-Granados R, Gonzalez-Escribano F, Gonzalez-Gay MA. Tubulointerstitial nephritis and uveitis syndrome in Southern Spain. Semin Arthritis Rheum. 2002;32(2):125–9.PubMedCrossRef
60.
Tanaka H, Waga S, Nakahata T, Suzuki K, Ito T, Onodera N, et al. Tubulointerstitial nephritis and uveitis syndrome in two siblings. Tohoku J Exp Med. 2001;194(1):71–4.PubMedCrossRef
61.
Matsuo T. Fluorescein angiographic features of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. 2002;109(1):132–6.PubMedCrossRef
62.
Deguchi HE, Amemiya T. Two cases of uveitis with tubulointerstitial nephritis in HTLV-1 carriers. Jpn J Ophthalmol. 2003;47(4):372–8.PubMedCrossRef
63.
Goda C, Kotake S, Ichiishi A, Namba K, Kitaichi N, Ohno S. Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. Am J Ophthalmol. 2005;140(4):637–41.PubMedCrossRef
64.
Hudde T, Heinz C, Neudorf U, Hoeft S, Heiligenhaus A, Steuhl K-P. Tubulointerstitielle Nephritis mit Uveitis. Klin Monbl Augenheilkd. 2002;219(7):528–32.PubMedCrossRef
65.
Howarth L, Gilbert RD, Bass P, Deshpande PV. Tubulointerstitial nephritis and uveitis in monozygotic twin boys. Pediatr Nephrol. 2004;19(8):917–9.PubMedCrossRef
66.
Joss N, Morris S, Young B, Geddes C. Granulomatous interstitial nephritis. Clin J Am Soc Nephrol. 2007;2(2):222–30.PubMedCrossRef
67.
Lim AKH, Roberts MA, Joon TL, Levidiotis V. Tubulointerstitial nephritis and uveitis syndrome: sore eyes and sick kidneys. Med J Aust. 2005;183(9):477–8.PubMedCrossRef
68.
Li JYZ, Yong TY, Bennett G, Barbara JA, Coates PTH. Human leucocyte antigen DQ alpha heterodimers and human leucocyte antigen DR alleles in tubulointerstitial nephritis and uveitis syndrome. Nephrology. 2008;13(8):755–7.PubMedCrossRef
69.
Svozilková P, Ríhová E, Kontur A, Plsková J, Jeníková D, Kovarík Z. TINU syndrome. Cesk Slov Oftalmol. 2006;62(4):255–62.PubMed
70.
Dusek J, Urbanova I, Stejskal J, Seeman T, Vondrak K, Janda J. Tubulointerstitial nephritis and uveitis syndrome in a mother and her son. Pediatr Nephrol. 2008;23(11):2091–3.PubMedCrossRef
71.
Mortajil F, Rezki H, Hachim K, Zahiri K, Ramdani B, Zaid D, et al. Acute tubulointerstitial nephritis and anterior uveitis (TINU syndrome): a report of two cases. Saudi J Kidney Dis Transpl. 2006;17(3):386–9.PubMed
72.
Yao Y, Yang JY. Two cases of tubulointerstitial nephritis and uveitis syndrome in children. Chin J Pediatr. 2007;45(4):310–1.
Metadata
Title
Tubulointerstitial nephritis and uveitis syndrome in an adolescent female: a case report
Authors
Tadej Petek
Maja Frelih
Nataša Marčun Varda
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Uveitis
Published in
Journal of Medical Case Reports / Issue 1/2021
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-021-03017-8

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