Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Successful treatment of tubulointerstitial nephritis and uveitis with steroid and azathioprine in a 12-year-old boy

  • Kim, Ji Eun (Department of Pediatrics, Institute of Kidney Disease Research, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Park, Se Jin (Department of Pediatrics, Daewoo General Hospital, Ajou University School of Medicine) ;
  • Oh, Ji Young (Department of Pediatrics, Institute of Kidney Disease Research, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Jeong, Hyeon Joo (Department of Pathology, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Ji Hong (Department of Pediatrics, Institute of Kidney Disease Research, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Shin, Jae Il (Department of Pediatrics, Institute of Kidney Disease Research, Severance Children's Hospital, Yonsei University College of Medicine)
  • Received : 2014.08.01
  • Accepted : 2014.10.23
  • Published : 2016.11.15
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Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, often underdiagnosed or misdiagnosed in children. We describe the case of a 12-year-old boy who presented to Severance Hospital with a 1-month history of bilateral conjunctival injection. He was first evaluated by an Ophthalmologist in another hospital and diagnosed with panuveitis. Laboratory tests indicated renal failure, and a renal biopsy confirmed the diagnosis of acute tubulointerstitial nephritis. An extensive exclusion of all possible causes allowed a diagnosis of TINU syndrome. The patient was treated with a systemic corticosteroid (initially prednisolone, 2 mg/kg and later deflazacort 1 mg/kg) and topical steroid drops for 1 month. Azathioprine was later added to the treatment regimen and the systemic steroid was slowly tapered. The final outcome of renal-ocular disease was favorable in the patient. However, long-term follow-up is necessary to properly manage frequent relapses and incomplete renal recovery. TINU should be considered as a differential diagnosis in children with uveitis or acute renal failure.

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References

  1. Dobrin RS, Vernier RL, Fish AL. Acute eosinophilic interstitial nephritis and renal failure with bone marrow-lymph node granulomas and anterior uveitis. A new syndrome. Am J Med 1975;59:325-33. https://doi.org/10.1016/0002-9343(75)90390-3
  2. Hahn HW, Ha IS, Yoo YS, Cheong HI, Choi Y. A case of tubulointerstitial nephritis and uveitis. J Korean Soc Pediatr Nephrol 2000;4:166-9.
  3. Han JM, Lee YJ, Woo SJ. A case of tubulointerstitial nephritis and uveitis syndrome in an elderly patient. Korean J Ophthalmol 2012; 26:398-401. https://doi.org/10.3341/kjo.2012.26.5.398
  4. Kim DH, Jang YS, Do WS, Oh DM, Kim SH, Kwak EK, et al. A case of tubulointerstitial nephritis and uveitis syndrome in an old age female. Korean J Nephrol 2010;29:250-5.
  5. Lee JW, Kim HJ, Sung SH, Lee SJ. A case of tubulointerstitial nephritis and uveitis syndrome with severe immunologic dysregulation. Pediatr Nephrol 2005;20:1805-8. https://doi.org/10.1007/s00467-005-2008-4
  6. Kim SM, Song JU, Choi ER, Choi HJ, Lee JE, Kwon GY, et al. An adult case of tubulointerstitial nephritis and uveitis syndrome in Korea. Korean J Nephrol 2008;27:606-10.
  7. Birnbacher R, Balzar E, Aufricht C, Schmaldienst S, Woloszczuk W, Forster E. Tubulointerstitial nephritis and uveitis: an immunological disorder? Pediatr Nephrol 1995;9:193-5. https://doi.org/10.1007/BF00860744
  8. Cigni A, Soro G, Faedda R, Caucci F, Amadori F, Manca A, et al. A case of adult-onset tubulointerstitial nephritis and uveitis ("TINU syndrome") associated with sacroileitis and Epstein-Barr virus infection with good spontaneous outcome. Am J Kidney Dis 2003;42:E4-10. https://doi.org/10.1053/S0272-6386(03)01257-5
  9. Stupp R, Mihatsch MJ, Matter L, Streuli RA. Acute tubulo-interstitial nephritis with uveitis (TINU syndrome) in a patient with serologic evidence for Chlamydia infection. Klin Wochenschr 1990;68:971-5. https://doi.org/10.1007/BF01646656
  10. Santoro D, Vita G, Rovito S, Venuto L, Cavallari V, Vita R, et al. Drug-induced TINU syndrome and genetic characterization. Clin Nephrol 2012;78:230-6. https://doi.org/10.5414/CN107119
  11. Tan Y, Yu F, Qu Z, Su T, Xing GQ, Wu LH, et al. Modified C-reactive protein might be a target autoantigen of TINU syndrome. Clin J Am Soc Nephrol 2011;6:93-100. https://doi.org/10.2215/CJN.09051209
  12. Hamdan JM, Obeidat FN. Tubulo-interstitial nephritis and uveitis syndrome in a 6-year-old boy: case report. Ann Trop Paediatr 2006;26:145-8. https://doi.org/10.1179/146532806X107502
  13. Paul E, Van Why S, Carpenter TO. Hyperthyroidism: a novel feature of the tubulointerstitial nephritis and uveitis syndrome. Pediatrics 1999;104(2 Pt 1):314-7. https://doi.org/10.1542/peds.104.2.314
  14. Vohra S, Eddy A, Levin AV, Taylor G, Laxer RM. Tubulointerstitial nephritis and uveitis in children and adolescents. Four new cases and a review of the literature. Pediatr Nephrol 1999;13:426-32. https://doi.org/10.1007/s004670050634
  15. Gion N, Stavrou P, Foster CS. Immunomodulatory therapy for chronic tubulointerstitial nephritis-associated uveitis. Am J Ophthalmol 2000;129:764-8. https://doi.org/10.1016/S0002-9394(00)00482-7