Repeat renal biopsy in a girl with tubulointerstitial nephritis and uveitis syndrome

Tanaka, Hiroshi; Suzuki, Koich; Nakahata, Tohru; Tateyama, Takashi; Waga, Shinobu; Ito, Etsuro

doi:10.1007/s004670100697

Cited by 28 publications

(30 citation statements)

References 9 publications

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“…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.…”

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confidence: 99%

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Chu

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Tubulointerstitial nephritis and uveitis (TINU) syndrome is considered a rare cause of acute tubulointerstitial nephritis (ATIN) that is usually associated with renal recovery. This study sought to investigate the diagnosis, prognosis, and contributing factors of TINU syndrome using a large cohort of patients with prospective follow-up.Design, setting, participants, & measurements This study included patients with TINU syndrome from a prospective cohort of patients with ATIN from 2007 to 2012. Clinical-pathologic data were collected at biopsy and autoantibodies against modified C-reactive protein (mCRP-Ab) were measured. Serum levels and renal tissue expression of Kreb von den Lunge-6 were also detected. Independent risk factors for poor renal outcome at 12 months and late-onset uveitis were analyzed.Results Thirty-one patients (28%) with biopsy-proven ATIN were classified as having TINU syndrome. Of these patients, 18 (58%) developed late-onset uveitis and were misdiagnosed as having drug-induced ATIN at the time of biopsy. An abnormal level of mCRP-Ab was an independent risk factor for late-onset uveitis (odds ratio, 14.7; 95% confidence interval, 3.4 to 64.0). Patients with TINU syndrome and drug-induced ATIN had comparable levels of Kreb von den Lunge-6 in both serum and renal tissues. Ninety-two percent of patients developed stage 3-4 CKD and/or tubular dysfunction by 12 months postbiopsy. Age, serum creatine level, erythrocyte sedimentation rate, and the presence of concomitant thyroid disease or leukocyturia were related to poor renal outcome. Relapse was seen in 36% (11 of 31) of patients and potentiated poor renal outcome. ConclusionsThe diagnosis of TINU syndrome can be missed in a large fraction of patients with ATIN because uveitis can present well after the onset of tubulointerstitial nephritis. Elevated mCRP-Ab levels may be useful in predicting late-onset uveitis TINU syndrome. Unfortunately, patients with TINU tended to have frequent relapses and most patients had incomplete renal recovery. Long-term follow-up is needed to prevent misdiagnosis and properly manage TINU syndrome.

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Section: Introductionmentioning

confidence: 99%

Tubulointerstitial Nephritis with Uveitis in Chinese Adults

Chu

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…14 In comparison with other renal diseases and normal controls, the high prevalence of serum anti-mCRP autoantibodies in TINU syndrome was impressive, especially in the active phase of nephritis. 14 Otherwise, some studies have described that renal tubulointerstitial infiltrates are primarily composed of activated lymphocytes, among which the helper/inducer T-cell subset is reported to be predominant, 22,23 furthermore, cell-mediated immunity, in particular delayed-type hypersensitivity, could play a large role in TINU syndrome. 24 Most of the studies describing immunohistochemical kidney analysis in TINU patients have demonstrated that interstitium is infiltrated mainly by T-cells together with monocytes/macrophages 25,26 and the case reports of Abed et al 22 and others have described that the helper/inducer T-cell subset was predominant in renal interstitial infiltration in TINU.…”

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Tubulointerstitial Nephritis and Uveitis Syndrome: Case Report and Review of the Literature

Aguilar¹,

Lonngi²,

de-la-Torre

2015

Ocular Immunology and Inflammation

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Purpose:To review the literature on tubulointerstitial nephritis and uveitis (TINU) syndrome, and to report a case of a patient with relapsing polychondritis (RP) and TINU syndrome. Method: TINU syndrome is a rare oculo-renal inflammatory disorder. It is more common in young women with autoimmune conditions, infections, systemic disease, and previous use of medications. We report the case of a 62-year-old woman with relapsing polychondritis and a 2-year history of acute, recurrent, asymmetric, bilateral, anterior, nongranulomatous uveitis accompanied by tubulointerstital nephritis. The patient was diagnosed with TINU syndrome associated with relapsing polychondritis. No cases of this association have been reported in the literature. The clinical features of TINU syndrome are discussed based on the published works. Conclusion: TINU is an uncommon syndrome; only about 200 cases have been reported in the literature related to infections, systemic disease, and previous use of medications such as antibiotics and non-steroidal anti-inflammatory drugs. We found that it can be associated with relapsing polychondritis; therefore, it is important to investigate symptoms of this disease since TINU syndrome can co-exist with it.

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“…Persistent renal dysfunction, ocular complications and chronic course may appear in some cases (5). Treatment is controversial but patients are usually treated with systemic corticosteroids and immunosuppressive drugs and the renal outcome in children is usually good but uveitis tends to follow a relapsing course (2,3).…”

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confidence: 99%