Abstract: TH-PO0077
Tubulointerstitial Nephritis and Uveitis in Pregnancy: A Diagnostic Dilemma
Session Information
- AKI: Pathogenesis and Disease Mechanisms
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kaur, Rupinder, UC Davis Health, Sacramento, California, United States
- McCoy, Cody Garrett, UC Davis Health, Sacramento, California, United States
- Ananthakrishnan, Shubha, UC Davis Health, Sacramento, California, United States
- Young, Brian Y., UC Davis Health, Sacramento, California, United States
Introduction
Tubulointerstitial nephritis and uveitis (TINU) is a rare autoimmune disorder characterized by acute interstitial nephritis and bilateral anterior uveitis. It primarily affects adolescents and young adults and is often underdiagnosed due to nonspecific symptoms. We present a case of suspected TINU in a pregnant patient.
Case Description
A 28-year-old pregnant woman at 30 weeks gestation presented with a 2-week history of blurry vision and ocular pain. Ophthalmologic evaluation confirmed granulomatous anterior uveitis (Figure 1). Workup revealed acute kidney injury (Cr of 13 mg/dl), proteinuria, and pyuria. Her renal function worsened, progressing to hemodialysis-dependent acute kidney injury (AKI-D). Infectious and serologic testing, including sarcoid, and renal ultrasound were largely unrevealing. With unexplained AKI-D and uveitis, TINU was suspected. After multidisciplinary discussion with the patient, renal biopsy was deferred due to possible risks during late pregnancy. Instead, empiric prednisone 1 mg/kg/day was initiated. After a week of steroids, the patient’s ocular symptoms and renal function rapidly improved, allowing for discontinuation of dialysis.
Discussion
In this case, the combination of anterior uveitis, AKI-D, pyuria and negative autoimmune with infectious workup raised strong clinical suspicion for TINU. Despite the lack of histologic confirmation, empiric steroid therapy led to marked renal recovery and symptom resolution, affirming the decision to treat. This approach underscores the importance of timely recognition and empiric management of TINU, especially when diagnostic limitations exist, in this case the inability to easily perform a renal biopsy in the setting of late pregnancy. A multidisciplinary strategy was essential in guiding safe and effective treatment while minimizing risks to both mother and fetus.