V SRINIVASA1, G KAN1, V MANICKAM1, V SRIVASTAVA1
1Townsville Hospital, Douglas, Australia
Background: Tubulointerstitial nephritis and anterior uveitis syndrome (TINU) is a rare disorder. It was first described in 1975 by Dobrin, and since then more than 250 cases have been recorded. Although reported in adolescents and females, it may present in all ages and in both sexes with a incidence rate of 0.1 to 2% worldwide. It has been suggested that it is underdiagnosed due to lack of recognition.
Case Report: We present a case of an 18 year old male who was admitted to hospital with bilateral anterior uveitis. Urinary beta 2 microglobulin was high at a value of 5802 ug/L and serum creatinine was raised at 110 micromol/l. Urine protein excretion rate was approximately 1.9 grams per day. Sarcoidosis was initially suspected, but serum ACE levels was negative and imaging of the chest was not suggestive. Additionally, MRI Brain and lumbar puncture were both negative. Renal biopsy was performed and revealed tubulointerstitial nephritis. Based on exclusion, a diagnosis of TINU was made. He was commenced on a course of oral steroids and following this his creatinine improved to 75 micromol/l. His proteinuria resolved and urinary beta 2 microglobulin has decreased to a value of 1563ug/L. The bilateral uveitis has disappeared.
Conclusions: TINU syndrome is a underdiagnosed disorder that should be considered in the differential diagnosis, for any patient presenting with anterior uveitis with associated renal impairment and high urinary beta 2 microglobulin. Urinary protein studies may be used in the workup of a patient with bilateral uveitis as this may increase detection of TINU. Renal involvement in TINU is responsive to steroids and portends a good prognosis.
Dr. Vinay Srinivasa is a advanced trainee currently working at the Townsville hospital.
He is in his final year of advanced training for general medicine and is currently doing his first year of renal advanced training at Townsville hospital. He is aiming to be a dual specialist in both nephrology and general medicine
He has a special interest in Glomerulonephritis and hypertension