Tubulointerstitial nephritis and uveitis syndrome in a female adult

Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease characterised by the association of acutetubulointerstitial nephritis and uveitis. It affects mainly children and young women. Drugs and infections may be precipitating factors. It is a diagnosis of exclusion. The mainstays of treatment are topical and systemic corticosteroids. Prognosis is usually favourable. We report a case of TINU which occurred in our unit. A 37-year-old woman presented with an influenza-like illness, bilateral ocular pain and blurred vision. Ophthalmological evaluation revealed bilateral anterior uveitis and later renal involvement was seen as acute tubulointerstitial nephritis. A diagnosis of TINU was assumed after exclusion of other systemic diseases. She was treated with topical corticosteroids for the uveitis and evolved favourably, with resolution of ocular symptoms and normalisation of serum creatinine and proteinuria. This case highlights the importance of a high degree of clinical suspicion to make the diagnosis of TINU syndrome.

Keywords: acute renal failure; ophthalmology; proteinurea; renal medicine.

Figure 1

Diffuse interstitial, predominantly mononuclear, inflammatory infiltrate with tubulitis. Some eosinophils are also noted (H&E, magnification ×100).

Figure 2

Periglomerular non-caseating granulomas with multinucleated giant cells (H&E, magnification ×100), with immunohistochemistry showing positive staining for CD68, a macrophage marker (lower right corner).