Abstract: TH-PO0646
More than Meets the Red Eye: A Case of Biopsy-Proven Tubulointerstitial Nephritis Heralded by Uveitis
Session Information
- Genetic Diseases of the Kidneys: Complex Kidney Traits
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1202 Genetic Diseases of the Kidneys: Complex Kidney Traits
Authors
- Lowe, Jessica Elise, Houston Methodist Hospital, Houston, Texas, United States
- Lyu, David, Houston Methodist Hospital, Houston, Texas, United States
- Farooqui, Ozer A., Houston Methodist Hospital, Houston, Texas, United States
- Khan, Ali R., Houston Methodist Hospital, Houston, Texas, United States
- Adrogue, Horacio E., Houston Methodist Hospital, Houston, Texas, United States
- Edwards, Angelina, Houston Methodist Hospital, Houston, Texas, United States
Introduction
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare autoimmune condition only seen in 0.1-2% of patients seen in specialized uveitis centers and more common among pediatric and female populations that solely affects renal and ophthalmologic function. Identification is challenging as it is a diagnosis of exclusion with often asynchronous onset of renal and ocular dysfunction, with renal manifestations commonly preceding the ocular findings. Here we present a case of an adult patient with a history of an autoimmune disorder who was first diagnosed with uveitis and later found to have biopsy-proven tubulointerstitial nephritis, consistent with TINU syndrome.
Case Description
A 52-year-old female with history of hypertension, hypothyroidism, prediabetes and obesity was seen in clinic for elevated creatinine of 1.20 mg/dL (baseline 0.7 mg/dL). She had an upper respiratory infection one month prior to bilateral sudden-onset uveitis diagnosed by an ophthalmologist, with poor response to steroid drops. Urinalysis showed no signs of active urinary sediment but elevated urine beta-2 microglobulin (β2M) (1019 mcg/L) with correlated elevated serum β2M (2.6 mg/dL). Immune serologic workup (ANA, ANCA, double-stranded DNA antibody, anti-Smith antibody, rheumatoid factor, serum electrophoresis, C3 and C4) was negative. Kidney ultrasound was unremarkable. Due to elevated creatinine, kidney biopsy was obtained, which demonstrated tubulo-interstitial inflammation with lymphocytes and eosinophils, confirming TINU diagnosis. Treatment with systemic steroids was discussed, but given concerns for weight gain, azathioprine 100 mg daily was initiated.
Discussion
Although there are currently no official guidelines for screening or monitoring for TINU syndrome, there have been recommendations for quarterly ophthalmologic screening up to 1 year after TIN diagnosis for earlier detection of TINU. This case highlights a patient who was diagnosed with uveitis prior to workup for renal dysfunction, which is reported to only occur in 21% of TINU cases. This poses a possible suggestion for routine renal function testing after uveitis diagnosis for further prompt diagnosis of TINU and the utility of urine β2M as a biomarker for tubular dysfunction.