Tubulointerstitial nephritis and uveitis post COVID-19 infection in an adult

Abstract

A woman in her 50s contracted COVID-19 and initially presented a few weeks afterwards with left eye pain and redness. She was diagnosed with uveitis and treated with glucocorticoid eye drops. Renal impairment was found on laboratory investigations performed following the diagnosis of uveitis, and urine testing showed proteinuria. Serological testing showed no cause for the new findings, and renal imaging was unremarkable. A renal biopsy was conducted and histology was consistent with tubulointerstitial nephritis. A diagnosis of tubulointerstitial nephritis with uveitis (TINU) was established, and she was given prednisolone, with resolution of proteinuria and improvement in renal function. While TINU is rare but well described in children, it can also uncommonly be a cause of renal impairment in adults post COVID-19 infection, similar to cases in children.

Keywords: Proteinuria; SARS-CoV-2.

Figure 1. H&E stain showing tubulointerstitial inflammation.

Figure 2. Immunostain showing CD3 positive lymphocytes.

Figure 3. Periodic acid-Schiff Stain showing tubulitis.

Figure 4. Creatinine trend post diagnosis and commencement of treatment. The solid arrow identifies the time of commencement of prednisolone and the dotted arrow marks the time of cessation of all immunosuppressive therapy.