Tubulointerstitial nephritis and uveitis: association with suppressed cellular immunity

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.