Enhanced Recognition, Treatment, and Prognosis of Tubulointerstitial Nephritis and Uveitis Syndrome

Friederike Mackensen, Justine R. Smith, James (Jim) Rosenbaum

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Purpose: Tubulointerstitial nephritis and uveitis syndrome (TINU) is a specific form of uveitis that is unfamiliar to most ophthalmologists. Thus, it is frequently overlooked in differential diagnosis. We hypothesized that recognition of subsets of uveitis can facilitate the diagnosis of rare entities such as TINU. Design: Retrospective case series. Participants: One thousand nine hundred eighty-five patients with uveitis. Methods: We performed a computerized database analysis of patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2005. The database includes details about ocular inflammation, including specific diagnosis, anatomic location, laterality, continuity, onset, complications, HLA-B27 status, and relative diagnostic certainty. Additionally, we reviewed all charts of patients diagnosed with TINU or with a presentation of uveitis that was typical of TINU (i.e., bilateral sudden-onset anterior uveitis). Main Outcome Measures: Prevalence of TINU in identifiable subsets of patients with uveitis, visual acuity (VA), and renal function. Results: Individuals with TINU (n = 33) represented 1.7% of all patients with uveitis. However, TINU was diagnosed in 32 of the 316 patients (10%) presenting with bilateral sudden-onset anterior uveitis and in 20 of 62 of these patients (32%) who were younger than 20 years. Creatinine levels were more likely to be elevated in patients older than 40. Most patients maintained excellent VA and did not develop clinically significant renal impairment. Conclusion: Tubulointerstitial nephritis and uveitis syndrome is a common cause of uveitis among patients who present with bilateral sudden-onset anterior uveitis. The size of this series clarifies the understanding of the relationship between renal and ocular disease; facilitates recognition of the syndrome; and adds to the knowledge on prognosis, complications, and role of antecedent medications.

Original languageEnglish (US)
JournalOphthalmology
Volume114
Issue number5
DOIs
StatePublished - May 2007

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Uveitis
Anterior Uveitis
Therapeutics
Kidney
Visual Acuity
Recognition (Psychology)
Tubulointerstitial nephritis and uveitis
Databases
HLA-B27 Antigen
Eye Diseases
Creatinine
Differential Diagnosis
Outcome Assessment (Health Care)
Inflammation

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Enhanced Recognition, Treatment, and Prognosis of Tubulointerstitial Nephritis and Uveitis Syndrome. / Mackensen, Friederike; Smith, Justine R.; Rosenbaum, James (Jim).

In: Ophthalmology, Vol. 114, No. 5, 05.2007.

Research output: Contribution to journalArticle

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abstract = "Purpose: Tubulointerstitial nephritis and uveitis syndrome (TINU) is a specific form of uveitis that is unfamiliar to most ophthalmologists. Thus, it is frequently overlooked in differential diagnosis. We hypothesized that recognition of subsets of uveitis can facilitate the diagnosis of rare entities such as TINU. Design: Retrospective case series. Participants: One thousand nine hundred eighty-five patients with uveitis. Methods: We performed a computerized database analysis of patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2005. The database includes details about ocular inflammation, including specific diagnosis, anatomic location, laterality, continuity, onset, complications, HLA-B27 status, and relative diagnostic certainty. Additionally, we reviewed all charts of patients diagnosed with TINU or with a presentation of uveitis that was typical of TINU (i.e., bilateral sudden-onset anterior uveitis). Main Outcome Measures: Prevalence of TINU in identifiable subsets of patients with uveitis, visual acuity (VA), and renal function. Results: Individuals with TINU (n = 33) represented 1.7{\%} of all patients with uveitis. However, TINU was diagnosed in 32 of the 316 patients (10{\%}) presenting with bilateral sudden-onset anterior uveitis and in 20 of 62 of these patients (32{\%}) who were younger than 20 years. Creatinine levels were more likely to be elevated in patients older than 40. Most patients maintained excellent VA and did not develop clinically significant renal impairment. Conclusion: Tubulointerstitial nephritis and uveitis syndrome is a common cause of uveitis among patients who present with bilateral sudden-onset anterior uveitis. The size of this series clarifies the understanding of the relationship between renal and ocular disease; facilitates recognition of the syndrome; and adds to the knowledge on prognosis, complications, and role of antecedent medications.",
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