Tubulointerstitial nephritis and uveitis in children and adolescents - Four new cases and a review of the literature

We identified 35 cases of tubulointerstitial nephritis and uveitis (TINU), 31 from a MEDLINE search (1966-1996) of the English literature and 4 from o ur hospital records (1988-1996), To meet the case definition, the patient h ad to be less than 18 years old and have TINU of unknown cause. Common pres enting symptoms included fatigue, weight loss, fever, and abdominal pain. T he uveitis was usually anterior and could occur at any time with respect to the onset of the renal disease. Common laboratory features included anemia , increased erythrocyte sedimentation rate, and decreased creatinine cleara nce. Most patients (33 of 35) had renal biopsies that commonly revealed an intense inflammatory interstitial infiltrate, glomerular sparing, and negat ive immunofluorescence studies. Of the 35 patients, 26 received systemic co rticosteroid therapy (5 of 26 for eye disease); 22 had follow-up for at lea st 1 year; 13 of 35 patients had a recurrence of their uveitis. The outcome in all 35 cases was normal renal function with no documented visual loss. In conclusion, TINU is a unique syndrome with characteristic clinical featu res, laboratory changes, and renal biopsy results. Treatment is controversi al, and the outcome in children, even if untreated, is excellent.