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Anjum Faruk Koreishi, Ria Desai, Andrea Birnbaum, Dmitry Pyatetsky, Debra A Goldstein; Tubulointerstitial Nephritis and Uveitis Syndrome: Characterization of Clinical Features. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3317.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical manifestations of patients with tubulointerstitial nephritis and uveitis syndrome (TINU) with a focus on posterior segment findings.
Patients diagnosed with TINU between 2010 and 2015 at a single tertiary referral center were identified. The diagnosis was based on the presence of acute bilateral anterior segment inflammation and evidence of kidney dysfunction. A retrospective chart review was performed to identify clinical findings and results of diagnostic testing.
A total of 17 patients were diagnosed with TINU between 2010 and 2015. Eight (58%) were female. Three were African-American, six were Caucasian, and seven were Hispanic. The average age of presentation was 19.1 years (range 7-49). Seven patients (41.2%) had isolated anterior uveitis. Ten patients (58.8%) had posterior segment findings. Three (17.6%) had small multifocal choroidal lesions. Eight (47.1%) had disc edema. Four (23.5%) had macular edema. One of the patients with bilateral disc edema and multifocal choroidal lesions also had bilateral neovascularization of the disc and vitreous hemorrhage at presentation. Two patients (11.8%) had subretinal neovascular membranes. Urine beta 2 microglobulin was elevated in all 15 patients tested. Of the 13 with upper limits reported, the value was several times the upper limit of normal. Three had renal biopsy showing interstitial nephritis, and one had a renal biopsy showing only chronic kidney disease. Of the seven patients tested for HLA-DRB1, six (85.7%) were positive. Patients underwent treatment with a combination of local and systemic corticosteroids. Eleven patients (64.7%) required systemic therapy, with seven patients (41.2%) requiring immunomodulatory therapy.
TINU may be seen in all age groups, but is more common in younger patients. Posterior segment manifestations, which are not clasically described in TINU, were present in the majority of patients in our series. All patients tested had elevated urine beta 2 microglobulin, and 85.7% were HLA-DRB1 positive. Careful fundus examination should be performed on all patients with TINU, as the posterior segment findings may have significant visual sequelae.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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