====== Tubulointerstitial Nephritis and Uveitis Syndrome (TINU) ======

==== Diagnostic Criteria ====
**Standardization of Uveitis Nomenclature Criteria 2021**
==Clinical Criteria==
  - Anterior uveitis with our without intermediate/posterior involvement
    - Anterior chamber cell
    - If vitritis, choroiditis or retinal vasculitis anterior chamber inflammation is also present 
  - Tubulointerstitial nephritis
    - Biopsy proven -OR-
    - Elevated urine β-2 microglobulin -AND-
    - Abnormal urinalysis or elevated creatinine
==Exclusion criteria==
    * Positive Syphilis serology
    * Evidence of Sarcoidosis 
      * bilateral hilar adenopathy -OR-
      * tissue biopsy with non-caseating granulomata

====Prevalence in Pediatric Populations====
  * Up to 32% in those with sudden onset bilateral anterior uveitis
  * In those with biopsy proven tubulointerstitial nephritis, 46% had uveitis but 84% if they were screened at the outset, then 3 and 6 months later.(3)
    * [[https://www.aaojournal.org/article/S0161-6420(12)01261-4/fulltext|Saarela V et al Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476–1481.]]

====Disease Course====

  * 88% have a chronic course with frequent relapses
  * Active disease can last > 2 years
  * 50% recurrence in some studies upon cessation of steroids

====Treatment====
  * Topical and oral steroids is the most common treatment.(3)
    * Prednisone 2 mg/kg/day to start given BID max dose of 60 mg
    * Tapering dose depends on kidney function testing
  * Given frequent long term need for steroids consider steroid sparing agents when possible
  * The following have been used in various studies
    * methotrexate (may accumulate in the kidneys and cause toxicity)
    * mycofphenolate mofetil
    * azathioprine
    * TNFα inhibitors
      * adalimumab
      * infliximab
      * golimumab
      * tocilizumab 
====Resources====
  - {{::tubulointerstitial_nephritis_and_uveitis_syndrome_in_pediatric_patients_2023.pdf | Tubulointerstitial Nephritis and Uveitis Syndrome in Pediatric Patients. Janetos TM et al. Ocular Immunology and Inflammation. 2023;31(10):1955-1964}} 
  - {{::classification_criteria_for_tubulointerstitial_nephritis_with_uveitis_syndrome_2021.pdf |Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for tubulointerstitial nephritis with uveitis syndrome. Am J Ophthalmol. 2021;228:225-261}}
  - {{::tubulointerstitial_nephritis_and_uveitis_syndrome_in_children-prospective_multicenter_study_2013.pdf |Saarela V et al Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476–1481.}}

{{tag>>uveitis}}