Abstract
Tubulointerstitial nephritis and uveitis syndrome is an immune-mediated inflammation involving the kidney and the eye. Uveitis is usually bilateral, non-granulomatous anterior uveitis, but posterior segment involvement has been reported.
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Keywords
Overview
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Definition
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Immune-mediated inflammation involving the kidney and the eye
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Uveitis is usually bilateral, non-granulomatous anterior uveitis, but posterior segment involvement has been reported
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Symptoms
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Pain
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Photophobia
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Blurry vision
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Laterality
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Bilateral
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Course
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Nephritis is self-limited and rarely recurs, but uveitis can become recurrent in 40%
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In 65% of cases, acute nephritis precedes uveitis by weeks to months; 20% uveitis precedes nephritis; 15% nephritis and uveitis occur concurrently
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Age of onset
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Children and adolescent, with median age of 15 years
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Gender/race
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F:M = 3:1
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No racial predilection
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Systemic association
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Tubulointerstitial nephritis: injury to renal tubules and interstitium (not involving the glomeruli), leading to decreased renal function
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Several HLA haplotypes have been associated with TINU, but HLA-DRB1*0102 represents the strongest association
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Exam: Ocular
Anterior segment
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Non-granulomatous AC inflammation, ranging from mild to severe
Posterior Segment
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Uncommon: papillitis, cystoid macular edema, retinal pigment epithelial detachments, retinal vascular sheathing, vitritis, neuroretinitis, multifocal choroiditis
Exam: Systemic
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Abdominal or flank pain
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Fatigue
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Fever
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Headache
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Anorexia and weight loss
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BP usually normal
Imaging
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OCT
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CME (rare)
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FA
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Optic nerve leakage or vascular staining (rare)
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Laboratory and Radiographic Testing
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Renal biopsy (for definitive diagnosis): tubulointerstitial nephritis
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Urinalysis: elevated beta-2 microglobulin, mild proteinuria, eosinophilia, pyuria or hematuria without infection, normoglycemic glycosuria, white cell casts
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Bloodwork: elevated serum creatinine or decreased creatinine clearance, anemia, abnormal LFTs, elevated ESR
Differential Diagnosis
Inflammatory diseases that can affect the kidney and the eye:
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Systemic lupus erythematosus
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Sarcoidosis
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Granulomatosis and polyangiitis
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Adamantiades-Behcet’s disease
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Sjögren’s syndrome
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IgA nephropathy (Berger’s disease)
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Post-streptococcal uveitis
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Syphilis
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Leptospirosis
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Brucellosis
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Tuberculosis
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Drug-induced TINU: NSAIDs, Chinese herb Goreisan, acetaminophen, codeine phosphate, lamotrigine, smoking synthetic cannabinoid
Treatment
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Nephritis responds favorably to systemic corticosteroids
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Uveitis responds well to topical or regional steroids, but in recurrent cases systemic IMT is employed, including methotrexate, azathioprine, and cyclosporine
Referral/Co-management
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Nephrology
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Small, K.W. (2021). Tubulointerstitial Nephritis and Uveitis Syndrome. In: Foster, C.S., Anesi, S.D., Chang, P.Y. (eds) Uveitis. Springer, Cham. https://doi.org/10.1007/978-3-030-52974-1_14
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DOI: https://doi.org/10.1007/978-3-030-52974-1_14
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