TINU syndrome: a probably underdiagnosed entity
Abstract
TINU syndrome (tubulointerstitial nephritis and uveitis) is a rare entity first described in 1975 by Dobrin et al. Since then, about 300 cases have been described in the literature. It typically affects children and adolescents with a clear predominance in women (9:1 in some studies). This disease consists of the association of systemic inflammatory syndrome, with an increase in acute phase reactants, proximal tubulo-interstitial nephropathy (glucosuria, leukocyturia) and non-granulomatous bilateral anterior uveitis, in most cases. We present a case of this entity with favorable evolution and therapeutic response. The initial symptoms were nonspecific, but there was a significant deterioration in renal function, for which steroid treatment was carried out with a successful response and without new relapses during follow-up.
References
2) Saarela V, Nuutinen M, Ala-Houhala M, Arikoski P, Rönnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476-81. doi: 10.1016/j.ophtha.2012.12.039.
3) Saarela V, Nuutinen M, Ala-Houhala M, Arikoski P, Rönnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476-81. doi: 10.1016/j.ophtha.2012.12.039.
4) Amaro D, Carreño E, Steeples LR, Oliveira-Ramos F, Marques-Neves C, Leal I. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review. Br J Ophthalmol. 2020;104(6):742-7. doi: 10.1136/bjophthalmol-2019-314926.
5) Tan Y, Yu F, Yang H, Chen M, Fang Q, Zhao MH. Autoantibodies against monomeric C-reactive protein in sera from patients with lupus nephritis are associated with disease activity and renal tubulointerstitial lesions. Hum Immunol. 2008;69(12):840-4. doi: 10.1016/j.humimm.2008.09.006.
6) Mandeville JT, Levinson RD, Holland GN. The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol. 2001;46(3):195-208. doi: 10.1016/s0039-6257(01)00261-2.
7) Carvalho TJ, Calça R, Cassis J, Mendes A. Tubulointerstitial nephritis and uveitis syndrome in a female adult. BMJ Case Rep. 2019;12(1):e227688. doi: 10.1136/bcr-2018-227688.
8) Simon AH, Alves-Filho G, Ribeiro-Alves MA. Acute tubulointerstitial nephritis and uveitis with antineutrophil cytoplasmic antibody. Am J Kidney Dis. 1996;28(1):124-7. doi: 10.1016/s0272-6386(96)90140-7.
9) Conz PA, Milan M, Bragantini L, La Greca G, Bevilacqua PA. TINU syndrome associated with reduced complement levels. Nephron. 2001;89(3):340-1. doi: 10.1159/000046096.
10) Pinheiro MA, Rocha MB, Neri BO, Parahyba IO, Moura LA, Oliveira CM, et al. TINU syndrome: review of the literature and case report. J Bras Nefrol. 2016;38(1):132-6. doi: 10.5935/0101-2800.20160019.
11) Rueda-Rueda T, Sánchez-Vicente JL, Moruno-Rodríguez A, Castilla-Martino M, López-Herrero F, Contreras-Díaz M, et al. Tubulointerstitial nephritis and uveitis syndrome (TINU). Treatment with immunosuppressive therapy. Arch Soc Esp Oftalmol. 2018;93(1):47-51. doi: 10.1016/j.oftal.2017.01.008.
12) Clive DM, Vanguri VK. The syndrome of tubulointerstitial nephritis with uveitis (TINU). Am J Kidney Dis. 2018;72(1):118-28. doi: 10.1053/j.ajkd.2017.11.013.
13) Legendre M, Devilliers H, Perard L, Groh M, Nefti H, Dussol B, et al. Clinicopathologic characteristics, treatment, and outcomes of tubulointerstitial nephritis and uveitis syndrome in adults: A national retrospective strobe-compliant study. Medicine (Baltimore). 2016;95(26):e3964. doi: 10.1097/MD.0000000000003964.
14) Pakzad-Vaezi K, Pepple KL. Tubulointerstitial nephritis and uveitis. Curr Opin Ophthalmol. 2017;28(6):629-35. doi: 10.1097/ICU.0000000000000421.
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