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1.
R. Birnbacher E. Balzar C. Aufricht S. Schmaldienst W. Woloszczuk E. Förster 《Pediatric nephrology (Berlin, Germany)》1995,9(2):193-195
A 14-year-old boy with tubulointerstitial nephritis and uveitis (TINU syndrome) is described. Nephropathy improved without systemic cortisone treatment, whereas uveitis relapsed and was treated with topical steroids. Blood cell immunological analysis and serum analysis revealed signs of cytotoxic T-cell, macrophage and granulocyte activation, which declined as the clinical symptoms improved. This may be interpreted as an indication of their significance as markers in the pathogenesis of this syndrome or as part of a microbial-triggered immune response. 相似文献
2.
Yao YH Lin CC Chung YM Yang AH Li SY Lin CC Lin YP Yang WC Yang CY 《Clinical nephrology》2011,75(Z1):75-78
We report a 57-year-old woman with concurrent tubulointerstitial nephritis and uveitis syndrome (TINU) and Fanconi's syndrome. She presented with sudden onset of bilateral ocular pain, blurred vision, acute renal failure, glucosuria and proteinuria. Slit lamp examination revealed acute bilateral anterior uveitis. Tubulointerstitial nephritis was confirmed by kidney biopsy. Laboratory examination revealed normoglycemic glucosuria, proteinuria, normal anion-gap metabolic acidosis, phosphaturia, urinary uric acid wasting and kaliuresis leading to hypokalemia. Her vision and renal function improved gradually after systemic steroid therapy. There have been rare reports of TINU syndrome which had features of Fanconi's syndrome. The prevalence of TINU syndrome may be underestimated, and its association with Fanconi's syndrome requires further investigation. 相似文献
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Tubulointerstitial nephritis and uveitis in association with Epstein-Barr virus infection 总被引:4,自引:0,他引:4
Jochen Grefer René Santer Tobias Ankermann Sylvia Faul Bernhard Nölle P. Eggert 《Pediatric nephrology (Berlin, Germany)》1999,13(4):336-339
The case of a 13.5-year-old girl with acute tubulointerstitial nephritis and uveitis (TINU syndrome) is presented. The etiology
of this rare syndrome, which in most cases involves female adolescents and usually regresses spontaneously, is still unknown.
An infection-triggered pathological immune reaction has been considered to play a role in the pathogenesis of this disorder.
Here we report for the first time the association of TINU syndrome and Epstein-Barr virus infection.
Received: 4 May 1998 / Revised: 20 August 1998 / Accepted: 26 August 1998 相似文献
6.
Acute renal failure due to tubulo-interstitial nephritis developed in a 15-year-old girl. The disease was accompanied by uveitis and an inflammatory syndrome, consisting of a markedly increased erythrocyte sedimentation rate and high serum gamma globulin levels. The nephropathy as well as the inflammatory syndrome subsided spontaneously. A topical antiphlogistic treatment healed the ocular disease, which has not relapsed so far. The association of acute tubulo-interstitial nephritis and acute uveitis observed in several patients has led to the identification of a specific syndrome with a very particular symptomatology and course, the so-called TINU syndrome, the interest of which resides in the predictability of the complete reversibility of the nephropathy either spontaneously or after steroid treatment, contrasting with the marked tendency towards relapse of the uveitis. The demonstration of circulating immune complexes in the serum during the acute phase of the illness, as in our patient, further points to the involvement of immune processes in the syndrome, but the origin and pathogenesis remain as yet unknown. 相似文献
7.
Liakopoulos V Ioannidis I Zengos N Karabatsas CH Karasavvidou F Salmas M Kanelaki E Eleftheriadis T Stefanidis I 《Renal failure》2006,28(4):355-359
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare entity first described in 1975, affecting mainly young women and adolescents. We present a case of a 52-year-old female patient (one of the oldest in the literature) who complained of fever, anorexia, nausea, and vomiting. After she was admitted to our hospital, laboratory tests revealed tubular proteinuria, elevated erythrocyte sedimentation rate (ESR), anemia, and renal insufficiency (serum creatinine 4.2 mg/dL) with metabolic acidosis. Ophthalmologic examination revealed anterior uveitis (iritis) and renal biopsy showed acute tubulointerstitial nephritis. The diagnosis of TINU syndrome was established and the patient was treated with oral corticosteroids. All symptoms and ophthalmologic abnormalities disappeared after 6 weeks of treatment. Renal function also recovered completely and remained stable at follow-up. TINU syndrome should be considered in the differential diagnosis of unexplained tubulointerstitial nephritis, especially in the presence of ocular findings. Corticosteroid therapy is still controversial, but it helps in the quick resolution of renal and mainly eye abnormalities. 相似文献
8.
A case of tubulointerstitial nephritis and uveitis syndrome with severe immunologic dysregulation 总被引:1,自引:0,他引:1
Idiopathic tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon condition, characterized by acute tubulointerstitial nephritis (TIN) with a favorable course and uveitis with a chronic relapsing course. The pathogenesis remains unclear, but a lymphocyte-mediated immune mechanism has been suggested. A 9-year-old boy was evaluated for fatigue and 2 kg of weight loss. Renal glucosuria, elevated urine 2-microglobulin (MG), progressive renal dysfunction, polyclonal hypergammaglobulinemia, various autoantibodies and abnormal lymphocyte phenotypes were found. A renal biopsy revealed acute TIN. After 2 months of treatment with prednisolone, renal function and polyclonal hypergammaglobulinemia were normalized. While tapering prednisolone, anterior uveitis developed, which was improved with topical steroid. But abnormal lymphocyte phenotypes and autoantibodies persisted on low-dose prednisolone. Uveitis became aggravated, and urine 2-MG increased again. The second renal biopsy (7 months later) was normal except for minimal focal interstitial fibrosis. Uveitis was not responsive to systemic steroids, but improved with additional cyclosporin. Abnormal lymphocyte phenotypes improved, and most autoantibodies disappeared. We report a rare case of idiopathic TINU syndrome with severe immunologic dysregulation, which correlated with the clinicopathological and biochemical parameters. The information about lymphocyte phenotypes and autoantibodies may provide more insight into the pathophysiology and the clinical course of uveitis in this rare disorder. 相似文献
9.
Ebihara I Hirayama K Usui J Seki M Higuchi F Oteki T Kobayashi M Yamagata K 《Clinical and experimental nephrology》2006,10(3):216-221
We report a 17-year-old male patient with tubulointerstitial nephritis and uveitis (TINU) associated with hyperthyroidism.
He presented with a 2-month history of fatigue, loss of appetite, low-grade fever, and a 12-kg weight loss when he was admitted
to our hospital. He had iritis, which was complicated by fibrin in the anterior chamber, diagnosed by slit-lamp examination.
On laboratory examinations, deteriorated renal function (blood urea nitrogen level was 25.9 mg/dl and creatinine level was
2.82 mg/dl) and elevated urinary levels of N-acetyl-β-D-glucosaminidase (33.1 U/l) and β2-microglobulin (78 600 μg/l) were observed. Serum thyroid-stimulating hormone (TSH) was
undetectable, at less than 0.01 μIU/ml, and free triiodothyronine and free thyroxine were elevated, up to 5.23 pg/ml and 2.85 ng/dl,
respectively. The titers of antithyroglobulin and antithyroid microsomal and TSH-receptor antibodies were not elevated. Abdominal
and thyroidal ultrasonography showed evident bilateral enlargement of the kidneys and diffuse enlargement of the thyroid gland.
Iodine-123 scintigraphy showed low uptake in the thyroid gland. The biopsied renal specimen showed mild edema and severe diffuse
infiltration of mononuclear cells and few eosinophils in the interstitium, without any glomerular or vascular abnormalities.
Based on the clinical features and pathological findings, a diagnosis of TINU syndrome with associated hyperthyroidism was
made. Treatment was started with 30 mg/day of prednisolone. The iritis disappeared, and the patient's clinical status improved
remarkably. This case suggests the possibility of thyroid dysfunction in some patients with TINU syndrome, and we believe
thyroid function should be measured in all TINU patients. Moreover, histopathological diagnosis of the thyroid glands before
treatment is necessary for TINU patients with thyroid dysfunction. 相似文献
10.
Acute eosinophilic interstitial nephritis and uveitis (TINU syndrome) associated with granulomatous hepatitis. 总被引:1,自引:0,他引:1
A Segev S Ben-Chitrit Y Orion F Segev J Bernheim J Bernheim Y A Mekori 《Clinical nephrology》1999,51(5):310-313
A 23-year-old male presented with renal failure, cholestatic liver enzyme elevation and uveitis. Percutaneous renal biopsy revealed marked eosinophilic infiltration of the renal interstitium, which made the diagnosis of TINU syndrome (Tubulo-Interstitial Nephritis and Uveitis). Percutaneous liver biopsy showed granulomatous hepatitis, which was not described as a part of TINU syndrome. The diagnostic dilemma and the literature are discussed. 相似文献
11.
Dusek J Urbanova I Stejskal J Seeman T Vondrak K Janda J 《Pediatric nephrology (Berlin, Germany)》2008,23(11):2091-2093
A mother and her son, both with tubulointerstitial nephritis and uveitis syndrome (TINU) are reported. The nephritis presented
itself at 13 years in the mother and at 10 years in her son. Glomerular filtration (GFR) decreased in both, and renal biopsies
confirmed the diagnosis. Nephritis preceded the onset of uveitis in both. Clinical course and renal function improved quickly
on oral steroids in the boy. The mother’s hyperazotemia decreased spontaneously (without steroids), but not to normal range,
and remained stable for 35 years of follow-up. Local steroids due to recurrences of uveitis were repeatedly needed in both.
We believe this is the first report on familial occurrence of inherited TINU syndrome in two generations. 相似文献
12.
Yasuda K Sasaki K Yamato M Rakugi H Isaka Y Hayashi T 《Clinical and experimental nephrology》2011,15(6):927-932
A 69-year-old Japanese woman without any specific medical or family history was admitted to our hospital for renal insufficiency
with proteinuria. On laboratory examinations, deteriorated renal function (blood urea nitrogen level was 34.9 mg/dL and creatinine
level was 1.78 mg/dL) and elevated urinary levels of N-acetyl-β-d-glucosaminidase (23.4 U/L) and β2-microgloblin (20200 μg/L) were observed. We performed a renal biopsy. The biopsied specimen
showed severe diffuse infiltration of mononuclear cells into the interstitium, with normal glomeruli, and these findings were
compatible with acute tubulointerstitial nephritis (ATIN). At that time, ATIN seemed to be idiopathic. We performed gallium
scintigraphy, and the results revealed uptake by the bilateral kidneys, thyroid gland, and right parotid gland. Serum thyroid
stimulating hormone (TSH) was undetectable, free triiodothyronine was normal (3.11 pg/mL), and free thyroxine was elevated
to 2.4 ng/dL. The titers of antithyroglobulin and antithyroid microsomal and TSH-receptor antibodies were not elevated. Two
months later, burning pain and conjunctival congestion developed in both eyes. She had uveitis, as diagnosed by slit-lamp
examination. Topical corticosteroid was used for the uveitis with success. We could not detect any cause of the uveitis, so
a diagnosis of tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) with associated hyperthyroidism was made.
Treatment was started with 15 mg/day of prednisolone. Now her renal function is slowly recovering. There are few reports of
TINU syndrome with transient hyperthyroidism. This case suggests the possibility of thyroid dysfunction in patients with TINU
syndrome. A laboratory evaluation of thyroid function should be considered in the diagnostic evaluation of TINU syndrome. 相似文献
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Tubulointerstitial nephritis and uveitis: association with suppressed cellular immunity 总被引:1,自引:0,他引:1
Gafter U.; Kalechman Y.; Zevin D.; Korzets A.; Livni E.; Klein T.; Sredni B.; Levi J. 《Nephrology, dialysis, transplantation》1993,8(9):821-826
It is suggested that tubulointerstitial nephritis and uveitis(TINU) is a cell-mediated immune disease with a favourable responseto treatment with steroids. However, long-term follow-up hasnot been described and data on immunological studies are limited.The aim of this study was to evaluate the clinical featuresin patients with TINU who have had a long follow-up period,and in parallel to assess their cellular immunity and HLA typing.Four women with TINU were followed for 5.7±3.6 years.On remission they were studied for T-cell-mediated immunityby skin tests, T-cell subpopulations, and lymphokine secretionin vitro. The lymphokines included interleukin-2, -interferon,tumour necrosis factor, and colony-stimulating factor. The invitro response to AS101, a previously described immunomodulator,was evaluated. HLA-typing was also performed. The nephritis,which occurred once, was resolved in all patients and did notrecur. In contrast, numerous relapses of uveitis occurred despitetopical or systemic steroid treatment. The patients' T-cellsubpopulations did not differ from controls, but they revealedanergy to skin tests and a very low secretion rate of lymphokines.AS101 corrected the suppressed secretion in vitro. A high frequencyof HLA-DR6 antigen was found in the TINU patients. TINU is probably a systemic disease with a chronic relapsingcourse of the uveitis but with complete clinical recovery ofthe nephritis. Both in vivo and in vitro T-cell functions aresuppressed during remission. 相似文献
15.
Sessa A Meroni M Battini G Viganò G Brambilla PL Paties CT 《Journal of nephrology》2000,13(5):377-380
Acute renal failure due to idiopathic tubulo-interstitial nephritis associated with bilateral uveitis (TINU syndrome) is a rare clinical event, contracted mainly by girls or women. Here we report the clinical follow-up regarding a 22-year-old woman with acute renal failure (creat. clearance 13.5 ml/min) due to idiopathic tubulo-interstitial nephritis documented by renal biopsy, after bilateral uveitis which healed with local prednisone. The clinical history and the clinical follow-up of our patient were typical of the TINU syndrome. We were able to exclude all diseases causing acute tubulo-interstitial nephritis such as systemic infection, hypersensitivity to drugs, Behcet's disease, Sjogren syndrome, sarcoidosis, systemic lupus or vasculitides. The patient recovered after systemic prednisone. 相似文献
16.
Repeat renal biopsy in a girl with tubulointerstitial nephritis and uveitis syndrome 总被引:1,自引:0,他引:1
H. Tanaka Koich Suzuki Tohru Nakahata Takashi Tateyama Shinobu Waga Etsuro Ito 《Pediatric nephrology (Berlin, Germany)》2001,16(11):885-887
A Japanese girl aged 8 years who presented with a 2-month history of uveitis subsequently developed tubulointerstitial nephritis.
A percutaneous renal biopsy revealed massive interstitial mononuclear cell infiltrates consisting of CD4-positive T cells.
Despite administration of topical corticosteroids, the ocular symptoms persisted. Systemic corticosteroid therapy dramatically
reduced the ocular symptoms and urinary β2-microglobulin (β 2MG) concentration. However, reducing the prednisolone dosage induced recurrence of uveitis associated with
increased levels of urinary β 2MG. The CD4-positive T cell infiltration persisted in the second renal biopsy performed 6 months
after the first renal biopsy. These observations suggest that the interstitial cell infiltration persists for a relatively
long time in a proportion of patients with tubulointerstitial nephritis and uveitis syndrome (TINU). Although the renal outcome
of TINU has been reported to be favorable, prolonged interstitial cell infiltration may affect long-term renal outcome. Selected
patients with TINU should be followed with close observation.
Received: 7 February 2001 / Revised: 8 June 2001 / Accepted: 27 June 2001 相似文献
17.
Vassilios Liakopoulos Iraklis Ioannidis Nikolaos Zengos Costas H. Karabatsas Foteini Karasavvidou Marios Salmas 《Renal failure》2013,35(4):355-359
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare entity first described in 1975, affecting mainly young women and adolescents. We present a case of a 52-year-old female patient (one of the oldest in the literature) who complained of fever, anorexia, nausea, and vomiting. After she was admitted to our hospital, laboratory tests revealed tubular proteinuria, elevated erythrocyte sedimentation rate (ESR), anemia, and renal insufficiency (serum creatinine 4.2 mg/dL) with metabolic acidosis. Ophthalmologic examination revealed anterior uveitis (iritis) and renal biopsy showed acute tubulointerstitial nephritis. The diagnosis of TINU syndrome was established and the patient was treated with oral corticosteroids. All symptoms and ophthalmologic abnormalities disappeared after 6 weeks of treatment. Renal function also recovered completely and remained stable at follow-up. TINU syndrome should be considered in the differential diagnosis of unexplained tubulointerstitial nephritis, especially in the presence of ocular findings. Corticosteroid therapy is still controversial, but it helps in the quick resolution of renal and mainly eye abnormalities. 相似文献
18.
Masayuki Honda Hiroaki Ueo Hiroshi Inoue Shigeru Nanbara Shinya Arinaga Tsukasa Asoh Tsuyoshi Akiyoshi 《Surgery today》1994,24(3):276-279
Neuroleptic malignant syndrome (NMS) is a potentially fatal complication which may develop in psychiatric patients taking neuroleptic drugs. We report herein the successful treatment of a 33-year-old schizophrenic man, prescribed neuroleptic drugs, who underwent an emergency operation for traumatic duodenal perforation with a retroperitoneal infection. Five days after the operation, he began to demonstrate clinical features consistent with NMS such as high fever, abnormalities in vital signs, leukocytosis, and an elevated serum level of creatine phosphokinase; however, these findings were first presumed to be secondary to either the preexisting tissue injuries or to postoperative complications. A definite diagnosis of NMS was thus delayed until muscle rigidity and autonomic instability became evident. After a tentative diagnosis of NMS had been made, sodium dantrolene, a drug used specifically for the treatment of NMS, was administered and the patient's condition remarkably improved. Since NMS can be induced by either interrupting the course of neuroleptic drugs or by the additional administration of sedative drugs, and since its mortality rate is high if prompt and appropriate treatment is not carried out, surgeons should bear in mind the possibility of NMS developing postoperatively in psychiatric patients. 相似文献
19.
Tausif Zar Wilner Samson Joseph Palmisano 《Nephrology, dialysis, transplantation》2007,22(8):2400-2401
A 20-year-old Asian woman with a well-established history ofsystematic lupus erythematosus (SLE) and lupus nephritis (WHOstage IVB) presented to the emergency department with generalizedarthralgia and headaches. Her current medications included cellcept1000 mg daily and prednisone 30 相似文献
20.
Repeat renal biopsy in tubulointerstitial nephritis and uveitis syndrome: report of a case 总被引:1,自引:0,他引:1
A Japanese girl aged 12 years who presented with a month history of uveitis developed a significant elevation of urinary beta 2 microglobulin (beta 2MG) up to 13,933 micrograms/l. A percutaneous renal biopsy revealed a dense CD4-positive T-cell infiltration with focal tubulitis in the interstitium. The tubulointerstitial score (TI score) described by Foster et al. was 7 points. She was diagnosed as having tubulointerstitial nephritis and uveitis syndrome (TINU). Due to the severe interstitial infiltration, a 6-month course of prednisolone at the dose of 30 mg per alternate day was started. The levels of urinary beta 2MG dramatically decreased following treatment and the renal function remained normal. The second renal biopsy performed 6 months later revealed mild persistent CD4-positive T-cell infiltration associated with 19% periglomerular thickening, with the TI score of 4 points. These clinical observations suggest that the interstitial cell infiltration persists for a relatively long time in a proportion of patients with TINU. Since persistent interstitial infiltration has been known to be harmful to the kidney, we therefore speculate that prompt administration of corticosteroids might be beneficial to these patients. Although the renal outcome of TINU has been reported to be favorable to date, patients with severe interstitial infiltration should be followed under close observation. Study of similar patients is needed to clarify our understanding of effective therapy for TINU. 相似文献