Clinical outcome and occurrence of uveitis in children with idiopathic tubulointerstitial nephritis

Abstract

Acute idiopathic tubulointerstitial nephritis (TIN) is considered a condition with a good long-term prognosis. However, there is evidence that some patients develop permanent renal impairment. The aim of this study was to evaluate the clinical characteristics of TIN at the time of diagnosis in children and determine whether the findings upon presentation predict renal outcome. The clinical data and biopsy findings from 26 children with idiopathic TIN admitted to four Finnish university hospitals were analyzed retrospectively. Twenty-five patients (96%) manifested renal insufficiency. After the mean follow-up time of 2.75 years (SD 2.5; 0.9-13.5), 4 patients (15%) had permanent renal insufficiency and 8 patients (31%) had persistent low-molecular weight proteinuria. Uveitis was found in 12 patients (46%). Four of these patients (33%) developed chronic uveitis. Our analysis showed that none of the laboratory or biopsy findings upon presentation prognosticated renal outcome. No correlation between renal disease and uveitis could be found either. The occurrence of uveitis among TIN patients was higher than previously reported. Uveitis may develop late and without recurrence of renal dysfunction. Therefore, follow-up by a pediatrician and by an ophthalmologist is warranted in children with acute TIN for at least 12 months from diagnosis.

Development of uveitis during systemic corticosteroid therapy in TINU syndrome

“…1), as has been already described in the literature [4]. The very interesting report of Jahnukainen et al [1] does not indicate whether uveitis developed during therapy with high-dose systemic corticosteroids.…”

“…We read with interest the article of Jahnukainen and colleagues [1] who presented 26 patients with tubulointerstitial nephritis. Twelve patients (46%) presented bilateral anterior uveitis associated with tubulointerstitial nephritis, also known as tubulointerstitial nephritis and uveitis (TINU) syndrome.…”

Acute tubulointerstitial nephritis

“…Although considered to be an unusual condition and a rare finding in patients with AIN, the prevalence of c The drug can bind to the TBM or deposit within the interstitium and act as a planted antigen. d The drug can elicit the production of antibodies and become deposited in the interstitium as circulating immune complexes [27] uveitis among children might reach 33% [47]. Usually, the onset of uveitis follows the onset of the interstitial nephritis, but may also occur before or concurrently.…”

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

“…The renal prognosis has been considered to be favorable, although this was largely based on case reports or retrospective studies of a small number of patients (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The long-term outcome of TINU syndrome, especially in adults, has not been well studied.…”