Kidney Week

Abstract: SA-PO058

AKI Due to Idiopathic Tubulointerstitial Nephritis with Uveitis Syndrome

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Kuruvada, Krishna Mohita, Department of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Krishna Mohita Kuruvada, MBBS

• Cheema, Moazam M., Department of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Moazam M. Cheema, MBBS

• DiFranza, Lanny T., Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Lanny T. DiFranza, MD

• Brogan, Maureen, Department of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Maureen Brogan, MD, FASN

• Sharma, Deep, Department of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Deep Sharma, MBBS

• Guillite, Kettia Nephtalie, Department of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States

Kettia Nephtalie Guillite, MD

Introduction

Tubulointerstitial nephritis with uveitis(TINU) syndrome is a rare oculorenal inflammatory disorder. It generally affects younger individuals and is more prevalent in females. Uveitis is often bilateral and develops simultaneously with renal disease. We report a case of TINU syndrome presenting with uveitis.

Case Description

27-year-old man with a history of GERD presented with left temporal headache and ocular symptoms including pain, foreign body sensation, photophobia, and redness, without preceding ocular trauma. He was taking aspirin for headaches and omeprazole 20mg for gastritis. Physical examination revealed no skin rash or peripheral edema. He was evaluated by ophthalmology and diagnosed with bilateral nongranulomatous anterior uveitis. Laboratory tests showed an elevated creatinine level of 2.76 mg/dl compared to a recent baseline of 1.3 mg/dl. Urinalysis revealed 6-10 WBCs, no RBCs, and a spot UPCR of 433 mg. ESR was elevated to 59mm/hr, and CRP was elevated to 5.1mg/dl. Urine beta 2 microglobulin was elevated to 19.55mg/L. Kidney ultrasound was unremarkable. Our differentials included Sjögren syndrome, SLE, granulomatosis with polyangiitis and infectious causes such as leptospirosis which were excluded based on serologies. Kidney biopsy showed acute and chronic interstitial nephritis with light microscopic findings of neutrophilic, eosinophilic, and lymphocytic tubulitis and a moderate degree of tubular atrophy and interstitial fibrosis. The simultaneous onset of bilateral acute anterior uveitis and biopsy-proven tubulointerstitial nephritis confirmed a diagnosis of TINU syndrome. The patient was started on systemic steroids and eventually kidney function returned to baseline.

Discussion

TINU syndrome is generally considered an autoimmune disease, with medications(such as NSAIDs and antibiotics) and infections acting as acquired risk factors. Serum beta-2 microglobulin is a sensitive biomarker of interstitial nephritis that is helpful in the diagnosis of TINU although a biopsy is confirmatory. Mainstay of treatment involves the use of corticosteroids which reduces oculorenal inflammation in the active phase. Our case highlights the importance of using a high index of suspicion when dealing with a patient with both uveitis and kidney dysfunction as early treatment reduces the risk of progression to CKD.