Tubulointerstitial Nephritis and Uveitis: A Case Report

TL;DR

A rare case of TINU syndrome with severe symptoms is reported, highlighting the importance of early diagnosis and treatment to prevent kidney damage.

Contribution

This case report presents a rare and severe manifestation of TINU syndrome requiring prolonged corticosteroid treatment and steroid-sparing therapies.

Findings

The patient's renal function recovered after three months of corticosteroid treatment.

Uveitis recurred with steroid taper, necessitating additional therapies.

TINU syndrome should be considered in patients with uveitis and kidney dysfunction.

Abstract

Tubulointerstitial nephritis and uveitis (TINU) is a rare disease of unknown pathogenesis that is characterized by tubulointerstitial nephritis and uveitis. Currently, there are over 250 reported cases of TINU syndrome. TINU syndrome typically presents with mild uveitis and nephritis that is self-limited; however, in this case, the symptoms were severe making it different from previous case reports. We present a case of a 29-year-old female with a history of cytomegalovirus (CMV) with a recent diagnosis of bilateral uveitis who was admitted for worsening systemic symptoms. Laboratory testing revealed acute renal insufficiency along with hematuria and proteinuria. A kidney biopsy revealed tubulointerstitial nephritis, and the patient was initiated on corticosteroids for the diagnosis of TINU. The patient’s renal function recovered to baseline after a prolonged three-month course of systemic steroids but had a recurrence of her uveitis with steroid taper requiring initiation of steroid-sparing therapies. TINU syndrome should be considered in patients presenting with uveitis and renal dysfunction. Prompt diagnosis is necessary to preserve renal function with corticosteroids. The prognosis for patients with TINU is variable, with a frequently recurring and relapsing course. More research is needed to determine the optimal treatment.

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