Tubulointerstitial Nephritis and Uveitis Syndrome (TINU)

Standardization of Uveitis Nomenclature Criteria 2021

1. Anterior uveitis with our without intermediate/posterior involvement
   1. Anterior chamber cell
   2. If vitritis, choroiditis or retinal vasculitis anterior chamber inflammation is also present
2. Tubulointerstitial nephritis
   1. Biopsy proven -OR-
   2. Elevated urine β-2 microglobulin -AND-
   3. Abnormal urinalysis or elevated creatinine

• Positive Syphilis serology
• Evidence of Sarcoidosis
  • bilateral hilar adenopathy -OR-
  • tissue biopsy with non-caseating granulomata

• 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)
  • Saarela V et al Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476–1481.

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

• 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

1. Tubulointerstitial Nephritis and Uveitis Syndrome in Pediatric Patients. Janetos TM et al. Ocular Immunology and Inflammation. 2023;31(10):1955-1964
2. Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for tubulointerstitial nephritis with uveitis syndrome. Am J Ophthalmol. 2021;228:225-261
3. Saarela V et al Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology. 2013;120(7):1476–1481.