Original article
Immunomodulatory therapy for chronic tubulointerstitial nephritis–associated uveitis

https://doi.org/10.1016/S0002-9394(00)00482-7Get rights and content

Abstract

PURPOSE: To describe the clinical course and treatment with immunomodulatory agents in patients with tubulointerstitial nephritis and uveitis syndrome.

METHODS: Retrospective analysis of the charts of six patients with tubulointerstitial nephritis and uveitis syndrome.

RESULTS: The mean (±SD) age was 24.3 (±16.5) years, range 13 to 49 years. Four patients were children, and two were adults. Three were men, and three were women. Five of the six patients had anterior uveitis, and one had panuveitis. All patients had several relapses despite treatment with topical, regional, and oral steroids and methotrexate in one case. The introduction or modification of immunosuppressants (methotrexate, azathioprine, or cyclosporin A) achieved control of the uveitis and prevented relapses over a mean (±SD) follow-up period of 19.66 (±10.01) months, range 6 to 34 months. No treatment-related side effects were observed.

CONCLUSIONS: Tubulointerstitial nephritis and uveitis syndrome is a distinct disease entity in which the nephritis typically resolves, but the uveitis often becomes chronic and is treatment resistant. Immunomodulatory agents can achieve control of the inflammation and prevent relapses.

Section snippets

Patients and methods

The charts of all patients with tubulointerstitial nephritis and uveitis seen at the Massachusetts Eye and Ear Infirmary between 1996 and 1999 were reviewed. Information regarding age, sex, race, renal biopsy results, interval between kidney and eye involvement, type of uveitis, topical and oral treatment for uveitis, visual acuity at presentation and at last examination, complications, and follow-up were analyzed.

Results

Six patients with tubulointerstitial nephritis and uveitis were seen at the Massachusetts Eye and Ear Infirmary and were included in the study. There were three men and three women; all were white. The mean (±SD) age was 24.3 (±16.5) years, with a range of 13 to 49 years. All patients presented with acute febrile illness associated with fatigue, malaise, and nausea. Laboratory investigations revealed high creatinine levels, proteinuria, and anemia. The diagnosis of tubulointerstitial nephritis

Case 1

: In 1997, a 13-year-old girl developed an acute febrile illness associated with fatigue, thirst, and nausea. Laboratory tests showed high creatinine levels and proteinuria, and clinical examination confirmed enlarged kidneys. Renal biopsy revealed tubulointerstitial nephritis.

Normalization of the renal function was achieved quickly with systemic prednisone therapy. Four months later and while the patient was still on prednisone, she complained of pain, redness, and photophobia in both eyes. An

Discussion

Acute interstitial nephritis has a variety of etiologies, including drugs (antibiotics, diuretics, nonsteroidal antiinflammatory drugs), infections (viruses, group A streptococcus, pneumococcus, Yersinia pseudotuberculosis, salmonella, legionella, mycobacteria, toxoplasma, leptospira) and immunologic disorders (sarcoidosis, Sjögren syndrome, scleroderma, systemic lupus, Still disease). Acute interstitial nephritis of unknown etiology is labeled idiopathic.2, 13, 22 The typical histologic

References (31)

  • Hausmann N, Neyer U, Haemmerle W. Akut rezidivierende Uveitis und idiopathische interstitielle nephritis—eine...
  • N Murray et al.

    Primary tubulointerstitial nephritis and uveitis syndrome

    Aust N Z J Ophthalmol

    (1993)
  • D Ellis et al.

    Acute interstitial nephritis in childrena report of 13 cases and review of the literature

    Pediatrics

    (1981)
  • Leumann EP, Nemeth J, Briner J. Akute interstitielle Nephritis und Uveitis: Ein neu erkanntes Krankheitsbild. Schweiz...
  • R Van Leusen et al.

    Acute tubulointerstitial nephritis and uveitis and favorable outcomes after five months of continuous peritoneal dialyses (CAPD)

    Neth J Med

    (1988)
  • Cited by (77)

    View all citing articles on Scopus
    View full text