2022 - 6 Issue

Case report

Tubulointerstitial Nephritis With Uveitis (Tinu Syndrome). A Case Report

Ester Kurašová
Jiří Orság ORCID – Viktor Klementa ORCID – Klára Marešová ORCID – Tomáš Tichý ORCID – Dominik Hraboš ORCID – Karel Krejčí ORCID

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DOI: 10.31348/2022/31

Published in Czech and Slovak Ophtalmology: 2022 - 6

Published on website: 30.12.2022

Keywords: TINU syndrome, tubulointerstitial nephritis, uveitis, mCRP

Summary

In this case report, we describe the case of a 50-year-old woman referred by her general practitioner to a pulmonologist in order to investigate persistent fever and elevation of C-reactive protein despite antibiotic treatment following a respiratory infection. The patient was examined extensively, during which rheumatology, gastroenterology, nephrology, ophthalmology, laboratory and imaging tests were performed. Due to a rapid progression of renal insufficiency with active urinary sediment, the patient was referred for a renal biopsy, which confirmed tubulointerstitial nephritis, followed by a diagnosis of bilateral anterior uveitis two months later - genetic testing was also conducted, which confirmed the diagnosis of tubulointerstitial nephritis with uveitis syndrome. Steroid treatment brought about a gradual reduction of proteinuria and a stabilisation of renal function.

References

  1. Regusci A, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F. Tubulointerstitial nephritis and uveitis syndrome: a systematic review. Nephrol Dial Transplant. 2022 Apr 25;37(5):876-886.
  2. Lee G, Ashfaq A. Tubulointerstitial nephritis and uveitis (TINU syndrome). Topic in UpToDate (Ministry of Health). Wolters Kluwer publication 2014. Topic 7189. Version 10.0.
  3. Suzuki H, Yoshioka K, Miyano M et al., Tubulointerstitial nephritis and uveitis (TINU) syndrome caused by the Chinese herb „Goreisan“. Clin Exp Nephrol. 2009 Feb;13(1):73-6.
  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 Jun;104(6):742-747.
  5. Tan Y, Yu F, Qu Z et al. Modified C-reactive protein might be a target autoantigen of TINU syndrome. Clin J Am Soc Nephrol. 2011 Jan;6(1):93-100.
  6. Wu Y, Potempa LA, El Kebir D, Filep JG. C-reactive protein and inflammation: conformational changes affect function. Biol Chem. 2015 Nov; 396(11):1181-97.
  7. Mirchi PT, Bednářová V, Hrušková Z. Syndrom TINU – tubulointersticiální nefritida s uveitidou. Postgraduální nefrologie. 2022; 20 (1), 29-31.
  8. Rueda-Rueda T, Sánchez-Vicente JL, Moruno-Rodríguez A et al. Tubulointerstitial nephritis and uveitis syndrome (TINU). Treatment with immunosuppressive therapy. Arch Soc Esp Oftalmol (Engl Ed). 2018 Jan;93(1):47-51.
  9. Clive DM, Vanguri VK. The Syndrome of Tubulointerstitial Nephritis With Uveitis (TINU). Am J Kidney Dis. 2018 Jul;72(1):118- 128.
  10. Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010;77(11):956-961.
  11. Derakhshan A, Derakhshan D. Acute tubulointerstitial nephritis in two sisters with simultaneous uveitis in one. Saudi J Kidney Dis Transpl. 2021 Mar-Apr;32(2):554-558.
  12. Raissian Y, Nasr SH, Larsen CP, et al. Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol. 2011;22(7):1343- 1352.