Caplash Sonny, Gangaputra Sapna, Kodati Shilpa, Tuchman Shamir, Srinivasalu Hemalatha, Sen H Nida
Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, 20814, United States.
Division of Pediatric Nephrology, Children's National Medical Center, Washington DC, 20010, United States.
Am J Ophthalmol Case Rep. 2018 Mar 8;10:253-256. doi: 10.1016/j.ajoc.2018.03.006. eCollection 2018 Jun.
To describe an atypical presentation of Tubulointerstitial Nephritis and Uveitis (TINU), with challenges in treatment course.
A 12-year-old Hispanic female presented to the National Eye Institute's Uveitis clinic with bilateral blurred vision, red eyes and photophobia, not responsive to topical steroids. On exam, she had bilateral severe panuveitis with areas of subretinal fluid. During her evaluation, she was noted to have elevated serum creatinine. A kidney biopsy confirmed the presence of severe tubulointerstitial nephritis and interstitial fibrosis. She was treated with oral steroids with excellent resolution of symptoms and subretinal fluid. She continued to have anterior segment flares with attempts to taper oral prednisone which lead to treatment with multiple immunomodulatory agents. Associated hypertension and kidney damage complicated the choice of a secondary immunosuppressive agent.
Although rare, TINU can present as panuveitis with choroidal involvement which may or may not be preceded by tubulointerstitial nephritis. A renal biopsy is required for definitive diagnosis, but abnormal urinalysis or renal function should raise suspicion for TINU.
描述肾小管间质性肾炎合并葡萄膜炎（TINU）的一种非典型表现以及治疗过程中遇到的挑战。
一名12岁的西班牙裔女性因双眼视力模糊、眼红和畏光就诊于国立眼科研究所葡萄膜炎诊所，局部使用类固醇治疗无效。检查发现，她双眼患有严重全葡萄膜炎，伴有视网膜下液区域。在评估过程中，发现她血清肌酐升高。肾活检证实存在严重肾小管间质性肾炎和间质纤维化。她接受口服类固醇治疗，症状和视网膜下液得到了很好的缓解。在尝试逐渐减少口服泼尼松剂量时，她的眼前节仍有炎症发作，这导致使用多种免疫调节药物进行治疗。合并的高血压和肾损害使二线免疫抑制剂的选择变得复杂。
尽管罕见，但TINU可表现为伴有脉络膜受累的全葡萄膜炎，其可能在肾小管间质性肾炎之前出现，也可能没有。明确诊断需要进行肾活检，但尿液分析异常或肾功能异常应引起对TINU的怀疑。
