Clinical Ophthalmology (Sep 2023)
Diagnostic and Management Strategies of Tubulointerstitial Nephritis and Uveitis Syndrome (TINU): Current Perspectives
Abstract
Julia Sanchez-Quiros,1,* Lena Giralt,2,* Alejandro Fonollosa,3,4 Ignacio Robles,5 Ester Carreño1,6 1Department of Ophthalmology, Rey Juan Carlos University Hospital, Madrid, Spain; 2Department of Ophthalmology, Hospital Clinic of Barcelona (ICOF), Barcelona, Spain; 3Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain; 4Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain; 5Department of Internal Medicine, Rey Juan Carlos University Hospital, Madrid, Spain; 6Department of Ophthalmology, Fundación Jiménez Díaz University Hospital, Madrid, Spain*These authors contributed equally to this workCorrespondence: Julia Sanchez-Quiros, Department of Ophthalmology, Rey Juan Carlos University Hospital, Calle Gladiolo s/n, 28933, Móstoles, Madrid, Spain, Email [email protected]: Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare autoimmune disease with unclear pathogenesis but probably related to a combination of genetic predisposition and environmental triggers. Diagnosis is challenging due to the asynchronous onset of renal and ocular symptoms, and it is necessary to exclude other causes of nephritis and uveitis. It affects both sexes, with an overall predominance of females and a median age of onset of 15 years. TINU syndrome is characterized by bilateral, non-granulomatous anterior uveitis and tubulointerstitial nephritis, which can cause acute renal failure in severe cases. Several triggers have been identified including concurrent infections, medications, or endocrine diseases. The diagnosis of TINU is mainly based on clinical and analytical findings, and although urinary β 2-microglobulin is a useful parameter no specific diagnostic test is available. Current perspectives intend to facilitate its diagnosis identifying susceptibility HLA genotypes, serologic markers and imaging tools to avoid renal biopsy. Treatment options for TINU syndrome include corticosteroids, immunosuppressive agents, and intravenous immunoglobulins, but relapses are frequent, and management can be challenging. The purpose of this review is to provide an updated summary of the diagnostic and treatment strategies of TINU syndrome, helping clinicians recognize and manage this rare autoimmune disorder.Keywords: TINU, uveitis, nephritis, inflammation
