Tubulo-interstitial nephritis and uveitis (TINU) syndrome 5/5 (1)

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Uveitis and kidney inflammation at the TINU syndrome. Barut K, 2015. CC BY 4.0

Definition

Tubulo-interstitial nephritis and uveitis syndrome (TINU syndrome) is an Autoimmune disease which attacks the eyes (iris inflammation / uveitis) and kidneys (Tubulo-interstitial nephritis, TIN). Thus, some symptoms may be reminiscent of rheumatic disease, but treatment and follow-up are usually done by an ophthalmologist and nephrologist. The condition was first described in 1975 and is rare.

Symptoms of TINU

TINU is most often seen among adolescents / teenagers, but onset in adulthood is also described. Women attack three times more often than men. TINU amounts to approx. 5% of cases of acute nephritis in the form of interstitial nephritis and 0.1-2% of uveitis (reference: Lopez BO, 2021).

Investigational Findings

Medical history covers current symptoms and is most relevant among adolescents, most often women.

Disease history with reduced general condition in the form of fever, fatigue, weight loss, abdominal / flank pain is common. Many have rheumatic symptoms. In one material, 17% had joint pain and muscle pain (reference: Mandeville JTH, 2001). Eyes may be painful, red, he reduced vision and photophobia as a sign of anterior iris inflammation (uveitis), often in both eyes. Chronic intestinal inflammation with abdominal pain and loose, bloody stools (inflammatory bowel disease / IBD) is also seen in up to 23% of cases (reference: Oikonomou K, 2011).

Clinical examination can detect eye inflammation, most often uveitis in both eyes. In 80%, the eye manifestations are on both islands (bilaterally). Sign up for reduced renal function can also be detected.

Blood tests may show low blood percentage (anemia), elevated CRP and blood lowering (SR). Increased number eosinophilia white blood cells are seen and elevated creatinine and decreased GFR at renal manifestation. High immunoglobulins with elevated IgG4 subclass also occur. 

Urine: Protein and erythrocytes in the urine are common

Stool sample (calprotectin) for symptoms of intestinal inflammation.

Tissue sample from kidney (Kidney Biopsy). «Acute tubulo-interstitial nephritis and tubular lesions» (reference: Mandeville JTH, 2001). In addition, tissue sample may indicate that IgG4 related disease available in some cases.

Similar diseases / differential diagnoses

Systemic lupus (SLE), Sjøgren's syndrome, Behçet's disease, ANCA-associated vasculitis and sarcoidosis.

Treatment

Cortisone eye drops and prednisolone tablets (reference: Habib GS, 2003). Supplementary immunosuppressive additional treatment if needed (reference: Joyce E, 2017).

Prognosis

Kidney failure decreases completely in 64%, while kidney transplantation is relevant in 13% in the long term. Eye manifestations recur in 40%. The prognosis depends on early diagnosis and the individual response to treatment (reference: Baker RS, 2004)

Literature



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