Severe Tubulointerstitial Nephritis and Uveitis: A Pediatric Case Report
Keywords:
Child, Nephritis, Interstitial, UveitisAbstract
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.Downloads
References
Okafor LO, Hewins P, Murray PI, Denniston AK. Tubulointerstitial nephritis and uveitis (TINU) syndrome: A systematic review of its epidemiology, demographics and risk factors. Orphanet J Rare Dis. 2017;12:128. doi:10.1186/s13023‐017‐0677‐2
Amaro D, Carreño E, Steeples LR, Oliveira‐Ramos F, Marques‐Neves C, Leal I. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review. Br J Ophthalmol. 2020;104:742‐7. doi:10.1136/ bjophthalmol‐2019‐314926
Chevalier A, Duflos C, Clave S, Boyer O, Hogan J, Lahoche A, et al. Renal prognosis in children with tubulointerstitial nephritis and uveitis syndrome. Kidney Int Rep. 2021;6: 3045‐53. doi:10.1016/j. ekir.2021.09.017
Regusci A, Lava SA, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F. Tubulointerstitial nephritis and uveitis syndrome: a systematic review. Nephrol Dial Transplant. 2022;37:876‐86. doi:10.1093/ndt/ gfab030
Mandeville JT, Levinson RD, Holland GN. The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol. 2001;46:195‐208. doi:10.1016/S0039‐6257(01)00261‐2
Kump LI, Cervantes‐Castañeda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. 2005;112:1287‐92. doi:10.1016/j.ophtha.2005.01.044
Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. 2007;114:995‐9. doi:10.1016/j. ophtha.2007.01.002
Wente‐Schulz S, Aksenova M, Awan A, Ambarsari CG, Becherucci F, Emma F, et al. Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross‐sectional web‐based survey. BMJ Open. 2021;11:e047059. doi:10.1136/ bmjopen‐2020‐047059
Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010;77:956‐61. doi:10.1038/ki.2010.89
Jahnukainen T, Saarela V, Arikoski P, Ylinen E, Rönnholm K, Ala‐Houhala M, et al. Prednisone in the treatment of tubulointerstitial nephritis in children. Pediatr Nephrol. 2013;28:1253‐60. doi:10.1007/s00467‐013‐2476‐x
González E, Gutiérrez E, Galeano C, Chevia C, de Sequera P, Bernis C, et al. Early steroid treatment improves the recovery of renal function in patients with drug‐induced acute interstitial nephritis. Kidney Int. 2008;73:940‐6. doi:10.1038/sj.ki.5002776
Clavé S, Rousset‐Rouvière C, Daniel L, Tsimaratos M. Acute tubulointerstitial nephritis in children and chronic kidney disease. Arch Pédiatr. 2019;26:290‐4. doi:10.1016/j.arcped.2019.05.002
Saarela V, Nuutinen M, Ala‐Houhala M, Arikoski P, Rönnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: A prospective multicenter study. Ophthalmology. 2013;120:1476‐81. doi:10.1016/j.ophtha.2012.12.039
Sobolewska B, Bayyoud T, Deuter C, Doycheva D, Zierhut M. Long‐term follow‐up of patients with tubulointerstitial nephritis and uveitis (TINU) syndrome. Ocul Immunol Inflamm. 2018;26:601‐7. doi:10 .1080/09273948.2016.1247872
Joyce E, Glasner P, Ranganathan S, Swiatecka‐Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017;32:577‐87. doi:10.1007/s00467‐016‐3394‐5
Kim L, Li A, Angeles‐Han S, Yeh S, Shantha J. Update on the management of uveitis in children: an overview for the clinician. Expert Rev Ophthalmol. 2019;14:211‐8. doi:10.1080/17469899.2019.1663731
Simonini G, Paudyal P, Jones GT, Cimaz R, Macfarlane GJ. Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta‐analysis approach. Rheumatology. 2013;52:825‐31. doi:10.1093/rheumatology/kes186
Rossert J. Drug‐induced acute interstitial nephritis. Kidney Int. 2001;60:804‐17. doi: 10.1046/j.1523‐1755.2001.060002804.x.
Sandeep Reddy Y, Abbdul Nabi S, Apparao C, Srilatha C, Manjusha
Y, Sri Ram Naveen P, et al. Hair dye related acute kidney injury – a clinical and experimental study. Ren Fail. 2012;34:880‐4. doi:10.310 9/0886022X.2012.687346
Brautbar N. Industrial solvents and kidney disease. Int J Occup Environ Health. 2004;10:79‐83. doi:10.1179/oeh.2004.10.1.79
Daniell WE, Couser WG, Rosenstock L. Occupational solvent exposure and glomerulonephritis. A case report and review of the literature. JAMA. 1988;259:2280‐3.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Pedro J. Miguel, Patrícia Costa-Reis, Inês Leal, João Boavida, José Esteves da Silva (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.