Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome Sana Khochtali Imen Ksiaa Anis Mahmoud...
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Transcript of Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome Sana Khochtali Imen Ksiaa Anis Mahmoud...
Tubulointerstitial Tubulointerstitial NephritisNephritis
and Uveitis (TINU) and Uveitis (TINU) SyndromeSyndromeSana KhochtaliSana KhochtaliImen KsiaaImen Ksiaa
Anis MahmoudAnis MahmoudBechir Jelliti Bechir Jelliti
Department of Ophthalmology Department of Ophthalmology Fattouma Bourguiba University Hospital Fattouma Bourguiba University Hospital
Faculty of Medicine, University of Monastir, Faculty of Medicine, University of Monastir, Monastir, TunisiaMonastir, Tunisia
Ocular History - First Ocular History - First PresentationPresentation
15-year-old girl 15-year-old girl OS : photophobia and tearing since OS : photophobia and tearing since
10 days10 days Improvement of symptoms with Improvement of symptoms with
topical steroids given by the parents topical steroids given by the parents Then also vision blurring, redness Then also vision blurring, redness
and photophobia of the OD and photophobia of the OD
June 2012 – First June 2012 – First PresentationPresentation
Visual acuity 20/50 OD, 20/40 OSVisual acuity 20/50 OD, 20/40 OS Intraocular pressure : 19 mmHg Intraocular pressure : 19 mmHg
OD, 16 mmHg OSOD, 16 mmHg OS No vitreous or vitreous haze OSNo vitreous or vitreous haze OS Fundus examination : Fundus examination :
unremarkable OSunremarkable OS
OD granulomatous anterior uveitis with fibrinous exudate in the anterior chamber
OS mild non –granulomatous anterior uveitis with extensive posterior synechiae
Work-up Work-up Chest X-ray : unremarkableChest X-ray : unremarkable Tuberculin-skin test : negativeTuberculin-skin test : negative Blood cell count : WBC count : 7700/mmBlood cell count : WBC count : 7700/mm33
Hb = 11 g/dlHb = 11 g/dl Syphilis serology : negativeSyphilis serology : negative Anti-nuclear antibodies and anti-streptolysine Anti-nuclear antibodies and anti-streptolysine
O antibodies : negativeO antibodies : negative HLA B27 typing : negativeHLA B27 typing : negative
First DiagnosisFirst Diagnosis
Idiopathic anterior uveitis
Treatment: intensive steroid drops and ointment at bedtime (with progressive tapering), as well as mydriatics
fever, malaise, fever, malaise, anorexia and diffuse arthralgiaanorexia and diffuse arthralgia Work-up: renal insufficiency and proteinuria Work-up: renal insufficiency and proteinuria Renal biopsy: acute tubulointerstitial nephritis Renal biopsy: acute tubulointerstitial nephritis Ophthalmological examination: Ophthalmological examination:
no clinical signs of active uveitisno clinical signs of active uveitis Laser flare values : 50 ph/ms OD and 46 Laser flare values : 50 ph/ms OD and 46
ph/ms OSph/ms OS
Follow up - Six weeks later Follow up - Six weeks later
Final diagnosis Final diagnosis
Tubulointerstitial Nephritis Tubulointerstitial Nephritis and Uveitisand Uveitis
(TINU) Syndrome(TINU) Syndrome
systemic prednisolone systemic prednisolone (starting dose of 1 mg/kg/day) (starting dose of 1 mg/kg/day)
maintained for 3 monthsmaintained for 3 months
Slit-lamp photographs show posterior synechiae , that are more prominent in the left eye
Follow-up Follow-up
Recovery of the renal functionRecovery of the renal function Visual acuity : 20/25 OD and 20/32 OS, flare within Visual acuity : 20/25 OD and 20/32 OS, flare within
normal limits normal limits
Four months after TINU syndrome diagnosis,
ConclusionsConclusions Although TINU syndrome is a rare cause of uveitis, it Although TINU syndrome is a rare cause of uveitis, it
should be highly suspected in patients with should be highly suspected in patients with bilateralbilateral anterior uveitis of sudden onset who are younger anterior uveitis of sudden onset who are younger than 20 years. than 20 years.
Urinalysis should be performed in such patientsUrinalysis should be performed in such patients
Uveitis may Uveitis may occur at the same time of, before or after occur at the same time of, before or after nephritisnephritis
ConclusionsConclusions Systemic steroids are usually prescribed to treat renal Systemic steroids are usually prescribed to treat renal
disease. However, they may be required to control disease. However, they may be required to control anterior uveitis if unresponsive to topical steroidsanterior uveitis if unresponsive to topical steroids
A close monitoring is helpful for timely detection of A close monitoring is helpful for timely detection of recurrences of ocular inflammation or insidious recurrences of ocular inflammation or insidious chronic anterior uveitischronic anterior uveitis
Posterior synechia are a common complication of Posterior synechia are a common complication of TINU syndrome-associated anterior uveitis TINU syndrome-associated anterior uveitis