NEPHROLOGY 2005; 10, 418–420 doi:10.1111/j.1440-1797.2005.00400.x © 2005 Asian Pacific Society of Nephrology. Blackwell Science, LtdOxford, UKNEPNephrology1320-53582005 Asian Pacific Society of Nephrology10unallocated418420Case Report Case with TINU syndromeK Kaynar et al. Correspondence: Dr Kubra Kaynar, Karadeniz Teknik Üniversitesi, T p Fakültesi, Nefroloji Bilim Dal , 61080 Trabzon, Turkey. Email: kkaynar@yahoo.com Accepted for publication 13 February 2005. y ¢ y ¢ Case Report Adult onset tubulointerstitial nephritis and uveitis syndrome KUBRA KAYNAR, 1 SAFAK ERSOZ, 2 NURETTIN AKYOL, 3 ONDER ERSOZ, 4 OZGE UNLU, 5 TULIN OZBAY 5 and SUKRU ULUSOY 1 Department of 1 Nephrology, 2 Pathology, 3 Ophthalmology, 4 Endocrinology and 5 Internal Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey SUMMARY: A Turkish woman aged 44 years who presented with a 1 month history of abdominal pain, fatigue and weight loss of 10 kg was diagnosed as having acute tubulointerstitial nephritis. Opthalmological evaluation revealed unilateral uveitis and contralateral chorioretinal scarring. X-ray films of the pelvis revealed unilateral sac- roileitis. An elevated erythrocyte sedimentation rate, C-reactive protein, tubular proteinuria and renal glucosuria returned to normal 2 weeks after treatment was started. It is important to be aware of tubulointerstitial nephritis and uveitis syndrome in order to achieve a quick diagnosis in patients with renal impairment and tubular dysfunction with minor symptoms so that appropriate management can be started early. KEY WORDS: acute tubulointerstitial nephritis, unilateral uveitis, sacroileitis. Uveitis in association with acute interstitial nephritis (AIN) was first described as a distinct entity by Dobrin and associates in 1975. 1 Tubulointerstitial nephritis and uveitis (TINU) syndrome is rare, with 133 cases identified in a recent review of world literature; 2 it accounts for 2% or less of patients in university-based uveitis practices. 3 TINU syn- drome is of particular interest because it has been thought to have an identifiable trigger in many cases, including the use of antibiotics in 24% of cases and the use of nonsteroidal anti-inflammatory agents in 18% of cases. 2 Similar trigger- ing agents have been identified for both isolated AIN and TINU syndrome, but it is not known whether TINU syn- drome and AIN without uveitis are different presentations of the same disease. Both cell-mediated immune responses and autoantibody production have been implicated in the pathogenesis of TINU syndrome. 2,4 Because many diseases might cause acute nephritis or uveitis, systemic infection, Sjögren syndrome, Behçet disease, systemic lupus erythema- tosus, vasculitis, hypersensitivity to drugs, sarcoidosis and Wegener’s granulomatosis have to be excluded. Although it accounts for 2% of adult and paediatric patients seen at university-based uveitis practices, its prev- alence might be higher because many cases might not be diagnosed. 5 Patients usually present with systemic signs and symptoms, including fatigue, malaise, anorexia, abdominal pain, fever and anaemia. The uveitis might precede, occur with or follow the nephropathy. 6 Because of their safety pro- file and the rapid onset of action, corticosteroids are usually the therapy of choice in the treatment of acute interstitial nephritis. If the patient shows a dramatic improvement in renal function on therapy with prednisone, the clinical course is favourable. We describe a case of TINU syndrome in a 44-year-old female patient with tubular dysfunction in the form of renal glucosuria, tubular proteinuria. CASE REPORT A 44-year-old woman presented with a 1 month history of abdominal pain, fatigue and anorexia with an associated 10 kg weight loss. There was no history of ingestion of any drugs. There was no significant past medical history. On examination, her height was 156 cm, weight was 75 kg and blood pressure was 140/90 mmHg. The physical examina- tion was unremarkable. A diagnosis of anterior non- granulomatous uveitis on the right eye and multifocal and focal chorioretinal scarring on the left eye was made. Laboratory findings showed 9.6 g/dL haemoglobin, 28.3% haematocrit and white blood cell count 8300/mL with 70% neutrophhils, 25% lymphocytes, 4% monocytes and 1% eosinophils. The erythrocyte sedimentation rate was 100 mm in the first hour. Other findings were as follows: C-reactive protein, 1.53 mg/dL (normal, <0.05 mg/dL); serum creatinine, 167 mmol/L; blood urea nitrogen, 6.6 mmol/L; uric acid, 147 mmol/L; total protein, 78 g/L; albumin, 36 g/L; sodium, 139 mmol/L; potassium, 3.5 mmol/L; chloride, 102 mEq/L; calcium, 2.0 mmol/L; phosphorus, 1.17 mmol/L; and fasting blood glucose, 4.5 mmol/L. Arterial blood gas analysis revealed pH 7.42, PCO 2 35 mmHg and HCO 3 – 22 mEq/L. Serum IgG was 1440 mg/dL (normal, 800–1700), IgA was 272 (normal, 100–490) and IgM was 178 (normal, 50–360). Serum com-