Transcript Case Report 43.76

Tubulointerstitial Nephritis
and Uveitis (TINU) Syndrome
Sana Khochtali
Imen Ksiaa
Anis Mahmoud
Bechir Jelliti
Department of Ophthalmology
Fattouma Bourguiba University Hospital
Faculty of Medicine, University of Monastir,
Monastir, Tunisia
Ocular History - First Presentation
15-year-old girl
 OS : photophobia and tearing since
10 days
 Improvement of symptoms with
topical steroids given by the parents
 Then also vision blurring, redness
and photophobia of the OD

June 2012 – First Presentation
 Visual
acuity 20/50 OD, 20/40 OS
 Intraocular pressure : 19 mmHg
OD, 16 mmHg OS
 No vitreous or vitreous haze OS
 Fundus examination :
unremarkable OS
 OD granulomatous anterior uveitis with
fibrinous exudate in the anterior chamber
 OS mild non –granulomatous anterior uveitis
with extensive posterior synechiae
Work-up
Chest X-ray : unremarkable
 Tuberculin-skin test : negative
 Blood cell count : WBC count : 7700/mm3
Hb = 11 g/dl
 Syphilis serology : negative
 Anti-nuclear antibodies and antistreptolysine O antibodies : negative
 HLA B27 typing : negative

First Diagnosis
 Idiopathic anterior uveitis
 Treatment: intensive steroid drops and
ointment at bedtime (with progressive
tapering), as well as mydriatics
Follow up - Six weeks later




fever, malaise, anorexia and diffuse arthralgia
Work-up: renal insufficiency and proteinuria
Renal biopsy: acute tubulointerstitial nephritis
Ophthalmological examination:
 no clinical signs of active uveitis
 Laser flare values : 50 ph/ms OD and 46
ph/ms OS
Final diagnosis
Tubulointerstitial Nephritis and Uveitis
(TINU) Syndrome
 systemic prednisolone
(starting dose of 1 mg/kg/day)
 maintained for 3 months
Follow-up
Four months after TINU syndrome diagnosis,


Recovery of the renal function
Visual acuity : 20/25 OD and 20/32 OS, flare within
normal limits
Slit-lamp photographs show posterior synechiae , that
are more prominent in the left eye
Conclusions

Although TINU syndrome is a rare cause of uveitis, it
should be highly suspected in patients with bilateral
anterior uveitis of sudden onset who are younger
than 20 years.

Urinalysis should be performed in such patients

Uveitis may occur at the same time of, before or after
nephritis
Conclusions

Systemic steroids are usually prescribed to treat renal
disease. However, they may be required to control
anterior uveitis if unresponsive to topical steroids

A close monitoring is helpful for timely detection of
recurrences of ocular inflammation or insidious
chronic anterior uveitis

Posterior synechia are a common complication of
TINU syndrome-associated anterior uveitis