title: Tubulointerstitial Nephritis and Uveitis Syndrome in an Elderly Man: Case Report and Literature Review.
abstract: Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease of unknown etiology defined by the combination of tubulointerstitial nephritis, uveitis, and biochemical abnormalities. It has been reported that TINU mainly affects adolescents and young women. Here we reported a special case regarding a 60-year-old man with acute renal failure due to TINU syndrome documented by renal biopsy.We present a rare case of an elderly patient, who had been suffering from a fever for 2 weeks, characterized by sudden onset and resolving spontaneously, and accompanied by extreme fatigue, loss of appetite, and shivering. Renal biopsy showed a tubulointerstitial nephritis, with polymorphonuclear infiltration and acute tubulitis. In the outpatient clinic, he was diagnosed with idiopathic bilateral anterior uveitis 1 month ago. Ophthalmological examination revealed anterior asymptomatic bilateral uveitis. Human leukocyte antigen (HLA) typing (HLA-DQA1*0101/0201 and HLA-DQB1*0303/0503) was found which supported the suspect of TINU syndrome. The patient was treated with oral prednisone (1 mg/kg) and continued for 8 weeks on tapering doses. Serum creatinine normalized within 3 and 6 months later renal function also recovered completely.This case highlights that TINU syndrome is probably an underdiagnosed disease responsible for some cases of idiopathic anterior uveitis in elderly male patients. It is of critical importance to be aware of this syndrome by nephrologist and ophthalmologists in this special population. Further studies are needed to elucidate clinical characteristic and pathogenesis of TINU syndrome in elderly population.
authors.affiliation: From the Department of Nephrology, Lishui Hospital of Zhejiang University, Lishui, Zhejiang Province (W-hL, JL, M-FM, C-YZ, LJ); Department of Infection Diseases and Department of Urology, The first hospital of Quanzhou affiliated to Fujian Medical University, Fujian Province (X-PY, JX); and Department of Radiology, Lishui Hospital of Zhejiang University, Zhejiang Province, People's Republic of China (J-SJ), Department of Nephrology,Qingyuan county people's hospital, Lishui, Zhejiang Province, China(C-FW).
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Lei
authors.forename: Jun
authors.initials: J
authors.lastname: Xin
authors.forename: Xue-Ping
authors.initials: XP
authors.lastname: Yu
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Mao
authors.forename: Jian-Song
authors.initials: JS
authors.lastname: Ji
authors.forename: Chui-Fen
authors.initials: CF
authors.lastname: Wu
authors.forename: Chao-Yong
authors.initials: CY
authors.lastname: Zhu
authors.forename: Lie
authors.initials: L
authors.lastname: Jin
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D059848:HLA-DQ alpha-Chains / Q000032:analysis; D059866:HLA-DQ beta-Chains / Q000032:analysis; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D013577:Syndrome; D014605:Uveitis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D059848:HLA-DQ alpha-Chains; D059866:HLA-DQ beta-Chains; C069050:HLA-DQA1 antigen; C069051:HLA-DQB1 antigen; D011241:Prednisone