U. Gafter et al., TUBULOINTERSTITIAL NEPHRITIS AND UVEITIS - ASSOCIATION WITH SUPPRESSED CELLULAR-IMMUNITY, Nephrology, dialysis, transplantation, 8(9), 1993, pp. 821-826
It is suggested that tubulointerstitial nephritis and uveitis (TINU) i
s a cell-mediated immune disease with a favourable response to treatme
nt with steroids. However, long-term follow-up has not been described
and data on immunological studies are limited. The aim of this study w
as to evaluate the clinical features in patients with TINU who have ha
d a long follow-up period, and in parallel to assess their cellular im
munity and HLA typing. Four women with TINU were followed for 5.7 +/-
3.6 years. On remission they were studied for T-cell-mediated immunity
by skin tests, T-cell subpopulations, and lymphokine secretion in vit
ro. The lymphokines included interleukin-2, gamma-interferon, tumour n
ecrosis factor, and colony-stimulating factor. The in vitro response t
o AS101, a previously described immunomodulator, was evaluated. HLA-ty
ping was also performed. The nephritis, which occurred once, was resol
ved in all patients and did not recur. In contrast, numerous relapses
of uveitis occurred despite topical or systemic steroid treatment. The
patients' T-cell subpopulations did not differ from controls, but the
y revealed anergy to skin tests and a very low secretion rate of lymph
okines. AS101 corrected the suppressed secretion in vitro. A high freq
uency of HLA-DR6 antigen was found in the TINU patients. TINU is proba
bly a systemic disease with a chronic relapsing course of the uveitis
but with complete clinical recovery of the nephritis. Both in vivo and
in vitro T-cell functions are suppressed during remission.