Abstract
Purpose:
To study complications and therapy of patients with Tubulointerstitial nephritis and uveitis (TINU) syndrome over a prolonged period.
Methods:
Retrospective observational study of 9 patients with TINU-Sydrome. All patients had standardized clinical and ophthalmological assessments. Diagnosis of TINU was confirmed via beta-2 microglobuline determination in urine (n= 8) and/or renal biopsy (n= 1).
Results:
Nine patients (5 female and 4 male) with TINU-Syndrome were followed up for a mean of 44.1 months (range 6-113 months). The mean age at diagnosis was 16.7 years (range 9-43 years). The anatomical diagnosis was bilateral anterior (5 patients), intermediate (3 patients) and panuveitis (1 patient). Complications involved were increased intraocular pressure due to a response to steroids (1 patient), development of optic disc edema (2 patients) and cystoid macular edema (2 patients). The treatment consisted in a stepladder approach beginning with local steroids (9 patients), systemic steroids (7 patients), immunosuppression (2x MTX, 1x Mycophenolic acid and 1x Mycophenolate mofetil) and anti-TNF alpha blocking agents (adalimumab; 2 patients). The number of relapses ranged between 0 and 7 (mean 1.9; 0: n= 2, 1-3: n= 6, 7: n= 1). The response to the final, adjusted regimen was quite acceptable and the patients could have been kept in prolonged periods of remission.
Conclusions:
In this study, analyzing the course of TINU patients for a prolonged period, we found 3 of 9 patients with intermediate uveitis and also one patient with panuveitis. Topical and/ or systemic corticosteroids were effective in 5 patients, while 4 received immunosuppression or biologicals. In our study TINU was characterized by reduced responsiveness to corticosteroid therapy and less by severe complications.
Keywords: 746 uveitis-clinical/animal model •
487 corticosteroids •
555 immunomodulation/immunoregulation