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Tarek Bayyoud, Christoph M E Deuter, Bianka Sobolewska, Manfred Zierhut; Clinic & Treatment of Tubulo-Interstitial Nephritis and Uveitis Syndrome (TINU). Invest. Ophthalmol. Vis. Sci. 2014;55(13):5316.
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© ARVO (1962-2015); The Authors (2016-present)
To study complications and therapy of patients with Tubulointerstitial nephritis and uveitis (TINU) syndrome over a prolonged period.
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).
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.
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.
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