A Report of an Adult Case of Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome, with a Review of 102 Japanese Cases
Unknown ethiology, Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Keiichiro Matsumoto, Kenichi Fukunari, Yuji Ikeda, Motoaki Miyazono, Tomoya Kishi, Ryoko Matsumoto, Makoto Fukuda, Saori Uchiumi, Mai Yoshizaki, Yasunori Nonaka, Akiko Kanaya
(Department of Internal Medicine, Saga University Faculty of Medicine, Saga City, Saga, Japan)
Am J Case Rep 2015; 16:119-123
Although TINU syndrome is characterized by idiopathic TIN with bilateral anterior uveitis, few reports have provided a comprehensive summary of the features of this disorder. Previous reports have suggested that many Japanese patients had HLA-A2 and -A24 (7), but there is no evidence.
Case Report: A 44-year-old female was referred to our hospital due to renal dysfunction in March 2012. After admission, her symptoms improved spontaneously without medication within 2 weeks. In the outpatient clinic, she was diagnosed with idiopathic bilateral anterior uveitis in May, and her renal dysfunction relapsed in November. A renal biopsy showed diffuse TIN. We made a diagnosis of TINU syndrome because we could not explain the origin, and treated her with a systemic corticosteroid. Her renal function and ocular symptoms have been improving. The patient had HLA-A24, -B7, -DR1, -C*07: 02 and -DQB1*05: 01: 01. We collected 102 Japanese cases in PubMed, Ovid MEDLINE, and the Japanese Medical Abstracts Society and compared our case with the previous cases.
Conclusions: This disorder affects primarily young females (median age, 14 years), and the most common symptom is fever (44/102 cases). We conducted a statistical analysis using contingency table and Pearson’s chi-square test, for HLA-A2 and A24, and calculated the odds ratio (OR). There are no significant differences (A2 was present in 7/22 cases and in 19/50 controls, p value (P) 0.61, OR 0.76 (95% confidence interval (CI)) 0.27–2.2; A24 was present in 10/22 cases and in 33/50 controls, P 0.10, OR 0.43, CI 0.16–1.2).
Keywords: Asian Continental Ancestry Group, Adult, Female, HLA-A Antigens, Humans, Japan - ethnology, Nephritis, Interstitial - therapy, Risk Factors, Syndrome, Uveitis - therapy