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      Tubulointerstitial nephritis and uveitis: The first report from the ophthalmology perspective in India

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          Abstract

          A 16-year-old boy presented with uveitis in both eyes with recurrent febrile illness and renal ailments. The patient was referred to a nephrologist. Subsequent investigations revealed acute tubulointerstitial nephritis in a renal biopsy and raised urinary beta-2 microglobulin (B2M). Based on his clinical findings and laboratory investigations, a diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was made. Since, the literature on TINU through India is sparse, the two available case reports were published through nephrology setup. Our case illustrates how ophthalmologist can aid in the diagnosis of such a rare clinical entity using interdisciplinary approach.

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          Global variation and pattern changes in epidemiology of uveitis.

          S Rathinam, P Namperumalsamy (2015)
          Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.
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            The tubulointerstitial nephritis and uveitis syndrome.

            J T Mandeville, R Levinson, G Holland (2015)
            The world's medical literature on tubulointerstitial nephritis and uveitis (TINU) syndrome was reviewed, and data on 133 patients with TINU syndrome were identified. The median age of onset was 15 years (range 9-74 years) with a 3:1 female-to-male predominance. Common laboratory abnormalities included elevated Westergren erythrocyte sedimentation rates and elevated urinary beta-2-microglobulin levels. Ocular symptoms preceded systemic symptoms in 21% of cases, and followed systemic symptoms by up to 14 months in 65% of cases. Uveitis involved only the anterior segment in 80% of cases. Uveitis was bilateral at presentation in 77% of cases. Patients were treated with systemic corticosteroids in 80% of cases and with immunosuppressive drugs in 9% of cases. Uveitis recurred or followed a chronic course in 56% of patients and persisted for several years in some cases. Ocular complications (including posterior synechiae, cataracts, and elevated intraocular pressure) were reported in 21% of cases. The visual prognosis appears to be good. Persistent renal dysfunction was reported in 11% of cases, including five patients who required renal dialysis. TINU syndrome is a distinct clinical entity that may be under-recognized and may account for some cases of unexplained chronic or recurrent uveitis. It is important for ophthalmologists, nephrologists, and primary care providers to be familiar with this disorder to ensure early diagnosis and appropriate treatment.
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              Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study.

              Matti Nuutinen, Ville Saarela, Marja Ala-Houhala … (2013)
              To evaluate the occurrence and characteristics of uveitis related to tubulointerstitial nephritis (TIN) in children.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (iso-abbrev): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): September 2020
                Publication date (Electronic): 20 August 2020
                Volume: 68
                Issue: 9
                Pages: 1993-1995
                Affiliations
                [1]Department of Uvea and Medical Retina, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
                [1 ]Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
                [2 ]Department of Uvea and Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
                Author notes
                Correspondence to: Dr. Jyotirmay Biswas, Department of Uvea and Ocular Pathology, Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu, India. E-mail: drjb@ 123456snmail.org
                Article
                Publisher ID: IJO-68-1993
                DOI: 10.4103/ijo.IJO_1461_19
                PMC ID: 7690543
                PubMed ID: 32823454
                SO-VID: 16b6efea-8595-4037-872b-8fb4a3bf8e98
                Copyright © Copyright: © 2020 Indian Journal of Ophthalmology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 10 August 2019
                Date revision received : 12 December 2019
                Date accepted : 18 January 2020
                Categories
                Subject: Case Reports

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: acute tubulointerstitial nephritis,immunomodulatory therapy,oculo-renal syndrome,tubulointerstitial nephritis and uveitis syndrome,urinary beta-2-microglobulin
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: acute tubulointerstitial nephritis, immunomodulatory therapy, oculo-renal syndrome, tubulointerstitial nephritis and uveitis syndrome, urinary beta-2-microglobulin

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