From the Research
Tubulointerstitial nephritis with uveitis (TINU) syndrome should be treated with corticosteroids as first-line therapy, with oral prednisone at 1 mg/kg/day (maximum 60 mg daily) for 2-4 weeks, followed by a gradual taper over 3-6 months, as this approach has been shown to be effective in managing the condition and improving patient outcomes 1.
Key Considerations
- TINU syndrome is a rare autoimmune disorder characterized by inflammation of the kidney tubules and the uvea of the eye, with a prevalence of approximately 1%-2% of uveitis cases 2.
- The etiology of TINU syndrome involves an autoimmune reaction to renal and ocular antigens, leading to interstitial inflammation and tubular damage in the kidneys, and anterior uveitis with acute onset of flares 1.
- Diagnostic criteria based on ocular examination, laboratory parameters, and renal biopsy emphasize the need to exclude other systemic diseases 1.
- Treatment options for TINU syndrome include corticosteroids, immunosuppressive agents, and intravenous immunoglobulins, but relapses are frequent, and management can be challenging 3.
Management Approach
- Corticosteroids are the primary treatment for TINU syndrome, with oral prednisone being the most commonly used agent 1, 4.
- Topical corticosteroid drops like prednisolone acetate 1% can be used to manage eye inflammation, along with cycloplegic agents such as cyclopentolate 1% to prevent iris adhesions [@Example@].
- In steroid-resistant cases, immunosuppressive agents like mycophenolate mofetil (500-1000 mg twice daily) or methotrexate (15-25 mg weekly) may be necessary 1, 3.
- Patients should be monitored with regular kidney function tests, urinalysis, and ophthalmologic examinations every 1-3 months during treatment to assess response to therapy and potential side effects [@Example@].
Prognosis and Outcomes
- The prognosis for patients with TINU syndrome is generally favorable, with most patients experiencing good outcomes when treated promptly 1, 5.
- However, some patients may develop chronic kidney disease or recurrent uveitis requiring long-term management 4, 2.
- Further research is needed to investigate the underlying triggers and mechanisms of TINU syndrome to develop targeted therapies and improve patient outcomes 1.