TUBULOINTERSTITIAL NEPHRITIS AND UVEITIS - ASSOCIATION WITH SUPPRESSED CELLULAR-IMMUNITY

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.