Three cases of tubulointerstitial nephritis and uveitis syndrome with different
clinical manifestations
#MMPMID27511057
Nagashima T
; Ishihara M
; Shibuya E
; Nakamura S
; Mizuki N
Int Ophthalmol
2017[Jun]; 37
(3
): 753-759
PMID27511057
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We here describe three different clinical manifestations of tubulointerstitial
nephritis and uveitis (TINU) syndrome. We examined and diagnosed the following 3
patients: a 15-year-old boy with bilateral anterior uveitis (Case 1), a
14-year-old girl with bilateral papilledema (Case 2), and a 49-year-old woman
with panuveitis (Case 3). The findings are presented herein. Case 1: The patient
had bilateral anterior uveitis. Urinalysis revealed markedly increased
?2-microglobulin and N-acetyl-?-D-glucosaminidase levels. As the patient was
pathologically diagnosed with tubulointerstitial nephritis (TIN), we diagnosed
TINU based on the presence of both uveitis and TIN. He was treated with oral
corticosteroids. Case 2: This patient showed anterior uveitis and papilledema in
both eyes. On initial examination, the urine test results did not show any
abnormality. Three months later, high ?2-microglobulin and
N-acetyl-?-D-glucosaminidase levels were detected. As the patient was clinically
diagnosed with TIN, we subsequently diagnosed TINU. Both the ocular and renal
findings improved without treatment. Case 3: The patient developed bilateral
panuveitis, retinal vasculitis, and macular edema, which were initially suspected
to be sarcoidosis. However, she was pathologically diagnosed with TIN 12 months
before the onset of uveitis; therefore, she was finally diagnosed with TINU. She
recovered with local corticosteroid administration only. TINU may present with
fundal features in addition to anterior uveitis. Detailed history taking and
urinalysis are important to determine the presence of tubular disorders in
similar patients.
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