Kidney Week

Abstract: SA-PO0318

Severe Tubulointerstitial Nephritis and Uveitis-Associated AKI in a 72-Year-Old Man After Herbal Supplement Use

Session Information

• AKI: Epidemiology and Risk Factors
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Babu, Nikhil, Emory University School of Medicine, Atlanta, Georgia, United States

Nikhil Babu, MD

• Asaolu, Gideon, Northeast Georgia Health System Inc, Gainesville, Georgia, United States

Gideon Asaolu, MD

• Trieu, Anh V., Emory University School of Medicine, Atlanta, Georgia, United States

Anh V. Trieu, PA-C

• Rahbari-Oskoui, Frederic F., Emory University School of Medicine, Atlanta, Georgia, United States

Frederic F. Rahbari-Oskoui, MD, MS, FASN

• Suarez, Jonathan J., Emory University School of Medicine, Atlanta, Georgia, United States

Jonathan J. Suarez, MD

Introduction

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare oculorenal condition with a mean age of 15 at diagnosis. While it is often idiopathic, TINU may be triggered by infections, medications or dietary supplements. We hereby report an unusual case of severe acute kidney injury (AKI) associated with TINU in an elderly male following herbal supplement use successfully treated with steroids resulting in complete recovery.

Case Description

A 72-year-old male without any significant past medical history presented with a 2 week history of uveitis and progressive fatigue. At presentation (Day 0), serum creatinine (SCr) was elevated at 4.83 mg/dL, rising to a peak of 8.07 mg/dL at Day 2, as depicted in Figure 1. Concomitantly, he was severely hyponatremic with serum sodium nadir of 112 mmol/L at Day 3. Due to severe metabolic derangements, he was started on continuous renal replacement therapy (CRRT) on day 2 till day 3. Urinalysis was significant for 70 mg/dL of protein, WBC clumps, large blood, and 30 RBC/hpf. Urine microscopy showed numerous non-dysmorphic RBCs and WBCs without casts. He admitted to consuming a herbal prep called Harad in the past months prior to presentation. Renal biopsy on Day 2 revealed acute tubulointerstitial nephritis and he was started on a high dose of IV pulse methylprednisolone followed by a prednisone taper. Renal function showed a steady improvement and within 2 months his SCr returned to baseline (0.88 mg/dL).

Discussion

Although TINU syndrome usually appears in children and young women, it should also be considered as a differential in older patients who present with otherwise unexplained AKI with concomitant ocular abnormalities. Early high-dose steroid therapy led to a complete resolution of his AKI.

Figure 1. Clinical course of a 72-year-old male with TINU syndrome. The trend highlights a rapid rise in serum creatinine to a peak of 8.07 mg/dL followed by recovery to baseline renal function after the initiation of pulse corticosteroid therapy on Day 2.