Vohra S, Eddy A, Levin A V, Taylor G, Laxer R M
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Pediatr Nephrol. 1999 Jun;13(5):426-32. doi: 10.1007/s004670050634.
We identified 35 cases of tubulointerstitial nephritis and uveitis (TINU), 31 from a MEDLINE search (1966-1996) of the English literature and 4 from our hospital records (1988-1996). To meet the case definition, the patient had to be less than 18 years old and have TINU of unknown cause. Common presenting symptoms included fatigue, weight loss, fever, and abdominal pain. The 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 clearance. Most patients (33 of 35) had renal biopsies that commonly revealed an intense inflammatory interstitial infiltrate, glomerular sparing, and negative immunofluorescence studies. Of the 35 patients, 26 received systemic corticosteroid therapy (5 of 26 for eye disease); 22 had follow-up for at least 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 features, laboratory changes, and renal biopsy results. Treatment is controversial, and the outcome in children, even if untreated, is excellent.
我们识别出35例肾小管间质性肾炎合并葡萄膜炎（TINU）病例，其中31例来自对1966年至1996年英文文献的MEDLINE检索，4例来自我们医院的记录（1988年至1996年）。为符合病例定义，患者必须年龄小于18岁且患有病因不明的TINU。常见的首发症状包括疲劳、体重减轻、发热和腹痛。葡萄膜炎通常为前部葡萄膜炎，可在肾病发病后的任何时间出现。常见的实验室特征包括贫血、红细胞沉降率升高和肌酐清除率降低。大多数患者（35例中的33例）接受了肾活检，结果通常显示有强烈的炎性间质浸润、肾小球未受累以及免疫荧光检查阴性。35例患者中，26例接受了全身糖皮质激素治疗（26例中有5例用于眼部疾病）；22例进行了至少1年的随访；35例患者中有13例葡萄膜炎复发。所有35例患者的肾功能均正常，无视力丧失的记录。总之，TINU是一种具有特征性临床特征、实验室改变和肾活检结果的独特综合征。治疗存在争议，儿童患者即使未经治疗，预后也很好。
