Severe Tubulointerstitial Nephritis and Uveitis: A Pediatric Case Report

Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare oculorenal inflammatory condition of unknown patho‐ genesis. It is thought to be an immune‐mediated process that can have multiple triggers, most notably infections or drugs; other toxic agents, such as hair‐dyes or paint thinners, have been associated with kidney injury, but their role as triggers of TINU is unknown. Usually, a complete recovery of renal function occurs, while the uveitis can be relapsing and challenging to control. We report a teenage girl with frequent contact with hair‐dyes and paint thinners, who initially presented with non‐oliguric acute kidney injury (AKI) of unknown etiology, requiring renal replacement therapy. Acute tubulointerstitial nephritis (TIN) was identified by kidney biopsy. Drugs, infectious and auto‐immune causes were excluded. Contact with hair‐dyes and paint thinners was stopped. The patient was treated with oral prednisolone, with complete recovery of renal function. Four months after the first symptoms, during corticosteroid taper, the patient developed eye redness, pain, photophobia and decreased visual acuity. Anterior bilateral uveitis and TINU syndrome were diagnosed. Eye inflammation was resistant to topical steroids associated with systemic steroids and methotrexate and resolved after adding adalimumab. Two years after initial presentation, the patient has normal renal function, normal urinary sediment and no proteinuria, normal blood pressure and absence of ocular inflammation. No relapses occurred under treatment with methotrexate and adalimumab.