Clinical manifestations and outcomes in tubulointerstitial nephritis and uveitis syndrome: a case report and a systematic review in China

Abstract

Purpose: Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon disease. We present a confirmed case of TINU syndrome, and a systematic review of epidemiological characteristics, clinical manifestations, management, and outcomes in Chinese patients.

Methods: A systematic search was carried out using defined terms and updated up to September 2022, in PubMed, Web of Science, Wanfang, CNKI, and VIP, to identify reported cases of TINU in China, according to PRISMA guidelines.

Results: An 18-year-old boy presented with elevated serum creatinine and 24-h urine protein level of > 2 g. Inspection result revealed acute tubulointerstitial nephritis, and bilateral uveitis. The patient was diagnosed with TINU syndrome and received treatment with methylprednisolone sodium succinate, which resulted in a significant decrease in creatinine and urinary protein levels. Systematic review identified 35 publications that met the inclusion criteria. A total of 71 cases were included in this article, of which 70 were from publications and 1 was from our hospital. The median age at onset was 42 years and was significantly lower in males than females (P < 0.05). The symptoms of uveitis often occurred after kidney injury (54%) and most uveitis was anterior (55%) and bilateral (75%). Among the 51 patients who were followed up for more than 6 months, 24 had recurrent ocular symptoms or progression to chronic uveitis. Twenty patients experienced chronic or progressive kidney disease.

Conclusion: TINU syndrome is prone to misdiagnosis because kidney damage may not occur simultaneously with uveitis. The incidence of kidney sequelae in children is lower than that in adults, and glucocorticoids are the preferred treatment.

Inplasy registration number: INPLASY202350050.

Keywords: Glucocorticoid; Systematic review; TINU syndrome; Tubulointerstitial nephritis; Uveitis.

Fig. 1

Results of renal biopsy. A Immunofluorescence: no immune complex deposit. B–D The electron microscope showed that the podocytes of the glomerulus were segmental fused, and there was no exact deposition of electronic dense matter in various parts of the glomerulus. (E) HE staining (×200). (F) PAS staining (×400). (G) PASM staining (×400). (H) Masson staining

Fig. 2

Slit lamp inspection results. (A) Right eye. (B) Left eye. The green arrow indicates keratic precipitates (KP)

Fig. 3

PRISMA study selection flowchart for systematic literature Review