June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Investigating the clinical value of urine β2-microglobulin (Uβ2M) in patients with tubulointerstitial nephritis and uveitis (TINU) syndrome
Author Affiliations & Notes
  • Lorraine Myers Provencher
    Ophthalmology, University of Iowa, Iowa City, Iowa, United States
  • Aaron Fairbanks
    Ophthalmology, University of Iowa, Iowa City, Iowa, United States
  • Nasreen A Syed
    Ophthalmology, University of Iowa, Iowa City, Iowa, United States
  • Footnotes
    Commercial Relationships   Lorraine Provencher, None; Aaron Fairbanks, None; Nasreen Syed, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2188. doi:
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      Lorraine Myers Provencher, Aaron Fairbanks, Nasreen A Syed; Investigating the clinical value of urine β2-microglobulin (Uβ2M) in patients with tubulointerstitial nephritis and uveitis (TINU) syndrome. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2188.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Uβ2M has emerged as a potential screening tool for TINU syndrome, but it is unknown whether Uβ2M could predict the course of uveitis in TINU, which is often chronic and relapsing. We seek to determine whether Uβ2M provides information on the course of the uveitis, i.e. disease activity, duration, or relapse.

Methods : IRB-approved, retrospective review of patients with TINU syndrome treated at the University of Iowa from 2009-2016. Inclusion criteria: clinical diagnosis of TINU based on anterior uveitis, elevated UB2M, and otherwise negative systemic workup. A uveitis score was used to quantify the degree of inflammation (sum of both eyes). Also evaluated: patient demographics, disease presentation and course, and duration.

Results : Eleven patients were identified. Mean age was 35y (range 4-81y); 7 female. Common presenting ocular complaints: redness (91%), photophobia (82%), and decreased vision (73%). All cases were eventually bilateral; 55% had unilateral onset with rapid, sequential involvement of the fellow eye. Of 22 eyes, initial visual acuity (VA) was ≥ 20/25 in 55% and ≥ 20/50 in 95%. Mean Uβ2M (normal < 160 μg/L) for all subjects was 6121 μg/L, (range 340-17494 μg/L). Mean Uβ2M for adults was 9761 μg/L and 1754 μg/L for those < 18y. Presenting serum creatinine (SCr) was normal in 4 patients, and 9 had 0-trace protein on urinalysis (UA). Uveitis scores (activity) trended with Uβ2M levels. Mean duration of disease was 21 months (range 1.1 – 51.5). Longer disease duration trended with higher initial Uβ2M levels. Mean follow up was 29 months (range 2.5-62). Final VA was ≥ 20/25 in 91% of eyes.

Conclusions : TINU affects all ages. Uveitis symptoms are classic, and involvement is often bilateral with sequential onset. Nephritis may be asymptomatic. SCr and UA (particularly urine protein) can be normal. Uβ2M is a useful diagnostic tool and appears to trend with the activity and duration of uveitis. Early identification of patients at risk for a complex course may reduce long-term complications associated with chronic uveitis.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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