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Tubulointerstitial nephritis and uveitis syndrome: a diagnosis that should be considered by rheumatologists
  1. G S Habib1,
  2. D Kushnir2,
  3. M Hyams3,
  4. V Frajewicki2
  1. 1Department of Internal Medicine B, Lady Davis Carmel Medical Centre, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
  2. 2Department of Nephrology, Lady Davis Carmel Medical Centre
  3. 3Department of Ophthalmology, Lady Davis Carmel Medical Centre
  1. Correspondence to:
    Dr G S Habib, Department of Internal Medicine B, Carmel Medical Centre, 7 Michal Street, Haifa 34362, Israel;
    gshabib62{at}yahoo.com

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Tubulointerstitial nephritis and uveitis (TINU) syndrome is an entity known mainly to the nephrologists. It has similar features to some of the rheumatic diseases, especially Sjögren’s syndrome and lupus. However, many rheumatologists are not familiar with this entity. TINU syndrome should be considered in the differential diagnosis in patients with renal and/or ocular involvement.

CASE REPORT

A 56 year old woman was referred to the rheumatologist for the evaluation of musculoskeletal pain, positive antinuclear antibody (ANA), and renal failure. She reported diffuse musculoskeletal pain for the past two months, with worsening of these symptoms during the past week. She denied morning stiffness or swelling of the joints. One month ago she also had sore eyes with some redness and was evaluated by an ophthalmologist, who prescribed “eye drops” with good results. She also had dry cough during the past month. Otherwise she had no chronic health problems. She denied dry mouth, photosensitivity, alopecia, oral or genital ulcers, Raynaud’s phenomenon, or swallowing problems. For the musculoskeletal pain she took simple analgesics only. A physical examination showed blood pressure 110/70 mm Hg, and diffuse trigger points without joint swelling. There was no organomegaly or lymphadenopathy. Skin was normal. Sclera and conjunctiva looked normal. Lungs were clear.

Laboratory studies showed a white cell count of 8.7×109/l, haemoglobin 103 g/l, packed cell volume 0.33, platelets 224×109/l, …

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