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2016 ; 17
(ä): 869-873
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A Rare Case of Tubulointerstitial Nephritis and Uveitis Syndrome Treated with a
Multi-Specialty Approach
#MMPMID27867184
Purt B
; Hiremath S
; Smith S
; Erzurum S
; Sarac E
Am J Case Rep
2016[Nov]; 17
(ä): 869-873
PMID27867184
show ga
BACKGROUND It is important for an ophthalmologist and nephrologist to look for
hidden causes of uveitis and nephritis, respectively. Delay in diagnosis leads to
increased morbidity and failure to systemically manage the patient results in
future recurrence of disease. It is likely that TINU remains underdiagnosed and
could potentially account for some of the cases of idiopathic uveitis, especially
when greater than 50% of uveitis cases have no identifiable cause. Fewer than 300
cases of tubulointerstitial nephritis and uveitis (TINU) syndrome have been
reported. In TINU syndrome, inflammation affects the renal tubules, interstitial
tissue, and uveal tract. Its pathogenesis remains poorly understood. CASE REPORT
We report a rare case of TINU syndrome in a 23-year-old female who was treated
using a multispecialty approach. Her primary care physician diagnosed her with
proteinuria and acute kidney injury and referred her to the nephrologist, who
later referred her to the ophthalmologist. A left kidney biopsy confirmed acute
interstitial nephritis. Following the discovery of a "pink eye", the patient was
referred to ophthalmology and diagnosed with anterior uveitis, confirming TINU
syndrome. Without the additional findings of uveitis, the diagnosis would have
been missed. Resolution was obtained through steroid therapy. CONCLUSIONS
Correctly diagnosing TINU syndrome requires a multispecialty approach and may not
be obvious upon initial presentation. Therefore, the ophthalmologist needs to
consider TINU in the differential diagnosis for a patient with bilateral uveitis
and evaluate a urinalysis for proteinuria as part of the work up.