ESPN 51th Annual Meeting

ESPN 2018


 
ISOLATED TINU SYNDROME IN AN ADOLESCENT GIRL
BURCU BOZKAYA YUCEL 1 MEHTAP EZEL ÇELAKIL 1 DERYA KARAMAN 2 FATMA SÜMER 3 Levent Karabaş 3 KENAN BEK 1

1- Kocaeli University Medical Faculty, Department of Pediatrics , Pediatric Nephrology Department, Kocaeli, Turkey
2- Kocaeli University Medical Faculty, Department of Pediatrics, Kocaeli, Turkey
3- Kocaeli University Medical Faculty, Department of Ophtalmology, Kocaeli, Turkey
 
Introduction:

In children tubulointerstitial nephritis and uveitis (TINU) syndrome is rare. Drugs, infections and autoimmunity are the major suspects in the pathogenesis. Probable immune-mediated events lead to tubulointerstitital inflammation sparing glomeruli and vessels along with non-granulomatous anterior uveitis. Clinical manifestations include fever, fatigue, weight loss, myalgia and headache. Uveitis presents as eye pain, redness, photophobia and sometimes with intraocular complications. Renal findings include flank pain, hematuria, proteinuria and acute renal failure usually with favorable outcome while uveitis may be chronic.

Material and methods:

Case

Results:

15 year old girl was admitted to the emergency department with fatigue and weight loss. Her blood pressure and physical findings were normal. She had used itraconazole for tinea capitis two months ago. Laboratory evaluation revealed elevated creatinine (2.2mg/dL), non-nephrotic proteinuria, normoglycemic glycosuria and sterile pyuria. Autoantibody panel was ANA++++, antidfs70+++ and antiJo1+. Renal biopsy resulted in tubulointerstitial nephritis. Opthalmologic slit lamp examination detected asymptomatic unilateral anterior uveitis. Topical and systemic steroids have been used for uveitis. Oral prednisolone (1mg/kg/day) was started and tapered over 4 weeks.  Serum creatinine decreased to normal levels subsequently and the patient was consulted to dermatology for the risk of developing dermatomyositis in future.

Conclusions:

Isolated TINU with no systemic rheumatologic condition is rare. Eye examination is a must in children with TIN even if asymptomatic. Close follow-up of TINU cases is necessary since it may go with relapses or systemic involvement may develop later in the course of the disease through autoimmune mechanisms.