Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

A case report of tubulointerstitial nephritis and uveitis syndrome in children with an unfavorable outcome

  • Sang I Kong (Department of Pediatrics, Konyang University Hospital) ;
  • Mun Hyang Park (Department of Pathology, Konyang University Hospital) ;
  • Eun Jung Cheon (Department of Pediatrics, Chungbuk National University Hospital)
  • Received : 2023.04.17
  • Accepted : 2023.06.09
  • Published : 2023.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis and uveitis in the absence of other systemic diseases. Three pediatric cases have been reported in the Republic of Korea, and we now report a fourth case. A 15-year-old girl presented to the ophthalmology department with a 1-week history of bilateral ocular discomfort that worsened on the day of presentation with redness and pain in both eyes. She was diagnosed with bilateral uveitis, and her baseline examination revealed moderate renal dysfunction and mild proteinuria. A renal biopsy was performed and confirmed the diagnosis of TINU syndrome. She was started on steroid eye drops and a 12-week course of oral steroids at a dose of 40 mg/m2/day, which completely resolved the proteinuria and mild renal function to an estimated glomerular filtration rate of 60 mL/min/1.73 m2. However, the uveitis did not improve, and despite the addition of oral methotrexate as a second-line treatment, the uveitis remains unresponsive to treatment over 21 months. Further evaluation and treatment are ongoing, and active therapeutic intervention is suggested even at a pediatric age, considering the lack of improvement in renal function and uveitis to date.

Keywords

References

  1. Dobrin RS, Vernier RL, Fish AL. Acute eosinophilic interstitial nephritis and renal failure with bone marrow-lymph node granulomas and anterior uveitis: a new syndrome. Am J Med 1975;59:325-33.  https://doi.org/10.1016/0002-9343(75)90390-3
  2. Okafor LO, Hewins P, Murray PI, Denniston AK. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a systematic review of its epidemiology, demographics and risk factors. Orphanet J Rare Dis 2017;12:128. 
  3. Mandeville JT, Levinson RD, Holland GN. The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol 2001;46:195-208.  https://doi.org/10.1016/S0039-6257(01)00261-2
  4. Regusci A, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F. Tubulointerstitial nephritis and uveitis syndrome: a systematic review. Nephrol Dial Transplant 2022;37:876-86.  https://doi.org/10.1093/ndt/gfab030
  5. Clive DM, Vanguri VK. The syndrome of tubulointerstitial nephritis with uveitis (TINU). Am J Kidney Dis 2018;72:118-28.  https://doi.org/10.1053/j.ajkd.2017.11.013
  6. Mortajil F, Rezki H, Hachim K, Zahiri K, Ramdani B, Zaid D, et al. Acute tubulointerstitial nephritis and anterior uveitis (TINU syndrome): a report of two cases. Saudi J Kidney Dis Transpl 2006;17:386-9. 
  7. Li C, Su T, Chu R, Li X, Yang L. Tubulointerstitial nephritis with uveitis in Chinese adults. Clin J Am Soc Nephrol 2014;9:21-8.  https://doi.org/10.2215/CJN.02540313
  8. Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology 2007;114:995-9.  https://doi.org/10.1016/j.ophtha.2007.01.002
  9. Hahn HW, Ha IS, Yoo YS, Cheong HI, Choi Y. A case of tubulointerstitial nephritis and uveitis (TINU). J Korean Soc Pediatr Nephrol 2000;4:166-9. 
  10. Kim JE, Park SJ, Oh JY, Jeong HJ, Kim JH, Shin JI. Successful treatment of tubulointerstitial nephritis and uveitis with steroid and azathioprine in a 12-year-old boy. Korean J Pediatr 2016;59(Suppl 1):S99-102.  https://doi.org/10.3345/kjp.2016.59.11.S99
  11. Lee JW, Kim HJ, Sung SH, Lee SJ. A case of tubulointerstitial nephritis and uveitis syndrome with severe immunologic dysregulation. Pediatr Nephrol 2005;20:1805-8.  https://doi.org/10.1007/s00467-005-2008-4
  12. Saarela V, Nuutinen M, Ala-Houhala M, Arikoski P, Ronnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology 2013;120:1476-81.  https://doi.org/10.1016/j.ophtha.2012.12.039
  13. Rytkonen S, Tainio J, Saarela V, Enden K, Kataja J, Arikoski P, et al. Long-term outcome of biopsy-proven idiopathic tubulointersitial nephritis with or without uveitis in children-a nationwide follow-up study. Pediatr Nephrol 2021;36:3663-71. https://doi.org/10.1007/s00467-021-05060-5