title: Tubulointerstitial Nephritis and Uveitis Syndrome: Are Drugs Offenders or Bystanders?
abstract: A 16-year-old female patient was admitted to our hospital due to progressive renal dysfunction with an increased serum creatinine (sCr) level of 1.7 mg/dL. Her clinical course without any ocular manifestations and results of drug-induced, lymphocyte-stimulating tests, in addition to a renal histological assessment, initially encouraged us to ascribe the patient's renal abnormalities to drug-induced acute interstitial nephritis (AIN). Four months later, she started to complain about reduced visual acuity when she was found to have anterior bilateral uveitis despite the recovered renal function with almost constant sCr levels around 0.7 mg/dL. Thus, a diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was finally made. Our case illustrates the difficulties in distinguishing late-onset uveitis TINU syndrome from drug-induced AIN at the time of the renal biopsy, thereby suggesting the importance of a longitudinal follow-up to overcome the potential underdiagnosis of the disease. Several diagnostic conundrums that emerged in this case are also discussed.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Kawamata
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Sugase
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Otani-Takei
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Miki
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takeda
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nagata
keywords: DLST; HLA; TINU syndrome; acute interstitial nephritis; uveitis