Unresolving AKI Diagnosed as a Case of Tubulo-Interstitial Nephritis with Uveitis Syndrome
- AKI: Mechanisms - Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
- Adhikari, Pabitra, Ascension Saint Francis, Evanston, Illinois, United States
- Devani, Raj, Ascension Saint Francis, Evanston, Illinois, United States
- Koirala, Prithul, Ascension Saint Francis, Evanston, Illinois, United States
Tubulo-interstitial nephritis and uveitis (TINU) is a very rare condition and till now around 250 cases have been reported so far. The pathogenesis of TINU syndrome remains unclear. Patients usually present with non-specific symptoms like nausea, vomiting and the ocular symptoms of uveitis might not always coincide with the diagnosis of acute kidney injury (AKI). The diagnosis can be easily missed with the clinical picture overlapping with prerenal etiology of AKI.
We report a case of a 67-year-old female with a past medical history of diabetes mellitus, hyperlipidemia, hypertension, Grave’s disease status post ablation presenting with nausea and vomiting for a few days. She was found to have acute kidney injury (AKI) with creatinine level of 2.06 mg/dl and was initially treated with intravenous fluids (IVF) as it was presumed to be prerenal with vomiting. However, the AKI did not improve with IVF and. Initial laboratory work ups were unremarkable to determine the etiology of AKI. Complete blood count showed a slightly raised eosinophil percentage of 5.7% (reference range less than 5%). Urinalysis demonstrated red blood cells (RBCs) of 6-10/ high power field (hpf) and glycosuria. On the third day of hospitalization, the patient had bilateral eye pain, redness and blurring of vision which was diagnosed as bilateral uveitis with posterior vitreous detachment. On further investigation, the patient had elevated urine Beta 2 Microglobulin of 3,704 ug/L (reference range 0-300 ug/L) and subsequent renal biopsy revealed tubulo-interstitial nephritis and diabetic glomerulopathy Class 2A thus confirming the diagnosis.
Ocular symptoms improved with topical steroids and renal function continued to platue for few weeks. Patient did not require systemic steroids. On regular oupatient follow up renal fuction continued to improve but did not reach the baseline.
TINU syndrome is a diagnosis of exclusion and can not be diagnosed by a single test. All the patients with suspected TINU syndrome do not undergo renal biopsy as kidney function usually improves with supportive treatment. Elevated urinary beta-2 microglobulin level is associated with TINU syndrome. Some severe cases might need systemic steroid therapy. It requires very high index of suspicion for timely diagnosis and management to prevent long term complications.