Tubulo Interstitial Nephritis and Uveitis Syndrome (TINU): Study of 5 Cases

Abstract

Tubulo interstitial nephritis and uveitis syndrome (TINU) is a rare disease characterized by association of intraocular inflammation and nephritis. We report study of 5 cases of TINU syndrome collected retrospectively in the internal medicine departments from 1996 to 2012. We found female predominance with female / male sex ratio at 4/1 and median age at 36.4 years. Uveitis was the first manifestation of the disease in all cases. 3 patients had systemic signs. All the patients had renal failure with proteinuria. Aseptic pyuria was noticed in 4 patients, microscopic hematuria in 2 patients and glucosuria without diabetes in one patient. All patients presented an elevated erythrocyte sedimentation rate. 3 patients had normochromic normocytic anemia and 2 patients had elevated level of gamma globulinemia. Kidney biopsy was performed in all patients. It showed acute interstitial nephritis in 1 case and chronic interstitial nephritis in 4 cases with segmental and focal glomerulosclerosis in 1 patient. All patients received oral corticosteroids. They were stopped in 3 cases and maintained in two cases. Residual renal failure was noticed in one case and one patient presented sequelae uveitis. One recurrence of uveitis was observed during progress after 2 years and a half. Progress was favorable. 3 patients had a good prognosis and the 2 others had an intermediate prognosis. TINU syndrome should be considered in the presence of any uveitis associated with renal impairment. Multidisciplinary management is recommended for early diagnosis and effective treatment