Bucher, Barbara

Bucher, Oliver

Lava, Sebastiano

Simonetti, Giacomo

Tschumi, Sibylle

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LETTER TO THE EDITORSDevelopment of uveitis during systemic corticosteroidtherapy in TINU syndromeSebastiano A. G. Lava & Oliver Bucher &Barbara S. Bucher & Giacomo D. Simonetti &Sibylle TschumiReceived: 24 January 2011 /Accepted: 15 February 2011 /Published online: 13 April 2011# IPNA 2011Sirs,We read with interest the article of Jahnukainen andcolleagues [1] who presented 26 patients with tubulointer-stitial nephritis. Twelve patients (46%) presented bilateralanterior uveitis associated with tubulointerstitial nephritis,also known as tubulointerstitial nephritis and uveitis(TINU) syndrome. One of these 12 patients developedthe uveitis prior to the nephrologic disease, in six, uveitiswas diagnosed within 2 weeks of the diagnosis ofnephritis, and in the remaining five between 3 and15 months after onset of the nephrologic symptoms.Despite the diagnosis of uveitis, seven patients presentedno ocular symptoms.We followed a 14 year-old female adolescent withunremarkable personal and familial history who com-plained about fever and headache. The symptomatictherapy did not improve the subjective complaints, and 5weeks later, leukocyturia, tubular proteinuria, and glu-cosuria ensued. Clinical examination was normal (bodyweight 58.5 kg, height 168 cm, blood pressure 118/70 mmHg, heart rate 76 beats/min); blood analysisrevealed a moderate anemia (hemoglobin 107 g/L)together with thrombocytosis (platelets 573 G/L) andelevated markers of inflammation (C-reactive protein87 mg/L, erythrocyte sedimentation rate 76 mm/h).Acute renal failure (creatinine up to 141 μmol/L ) andpersistent signs of tubular damage induced us to performa renal biopsy, which highlighted severe acute tubuloin-terstitial nephritis. At that time, ophthalmological exam-ination was normal, and the etiology of interstitialnephritis was unknown. Therapy with systemic cortico-steroids was started: methylprednisolone endovenous10 mg/kg for 3 days, followed by oral prednisolone80 mg daily, which was tapered in the following4 months. Nephritis rapidly improved (creatinine andurea decreased to normal values; glucosuria and tubularproteinuria disappeared, Fig. 1). However, 2 monthslater, still under high-dose systemic corticosteroids(0.5 mg/kg/d), the patient presented with pain and rednessof both eyes. Ophthalmological examination revealedanterior bilateral uveitis, which was successfully treatedwith topical corticosteroids.TINU syndrome was first described 1975 by Dobrin andcolleagues [2]. Uveitis usually follows nephritis, with adelay of 3 months on average [3]. In our case, uveitisensued when the patient was still under systemic high-dosecorticosteroids (Fig. 1), as has been already described in theliterature [4]. The very interesting report of Jahnukainen etal. [1] does not indicate whether uveitis developed duringtherapy with high-dose systemic corticosteroids.TINU syndrome is a rare diagnosis, which should besuspected when a young patient presents with interstitialnephritis. As uveitis may rarely also occur during high-dosetreatment with systemic corticosteroids and can be asymp-tomatic, regular ophthalmological follow-up is warranted inpatients with tubulointerstitial nephritis.S. A. G. Lava :O. Bucher :B. S. Bucher :G. D. Simonetti (*) :S. TschumiDepartment of Pediatrics, Pediatric Nephrology Unit, Inselspital,3010 Bern, Switzerlande-mail: Giacomo.simonetti@insel.chPediatr Nephrol (2011) 26:1177–1178DOI 10.1007/s00467-011-1853-6References1. Jahnukainen T, Ala-Houhala M, Karikoski R, Kataja J, Saarela V,Nuutinen M (2011) Clinical outcome and occurrence of uveitis inchildren with idiopathic tubulointerstitial nephritis. Pediatr Nephrol26:291–2992. Dobrin RS, Vernier RL, Fish AL (1975) Acute eosinophilicinterstitial nephritis and renal failure with bone marrow-lymphnode granulomas and anterior uveitis. A new syndrome. Am J Med59:325–3333. Mandeville JT, Levinson RD, Holland GN (2001) The tubu-lointerstitial nephritis and uveitis syndrome. Surv Ophthalmol46:195–2084. Grefer J, Santer R, Ankermann T, Faul S, Nölle B, Eggert P (1999)Tubulointerstitial nephritis and uveitis in association with epstein-barr virus infection. Pediatr Nephrol 13:336–3390 50 100 150 20060801001201402468102345mol/lCreatininemmol/lUreaDaysmmol/lPotassiumCorticosteroidsDiagnosis uveitisFig. 1 A 14-year-old female adolescent developed bilateral anterioruveitis during high-dose corticosteroid therapy 2 months after thediagnosis of tubulointerstitial nephritis (arrow), allowing the finaldiagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome.Systemic corticosteroid dose is indicated in the text1178 Pediatr Nephrol (2011) 26:1177–1178

Development of uveitis during systemic corticosteroid therapy in TINU syndrome

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Development of uveitis during systemic corticosteroid therapy in TINU syndrome

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