TINU (tubulo-interstitial nephritis and uveitis)

First described in 1975, it is a specific form of inflammation that commonly affects teenaged women and young adults. Relatively rare and probably frequently missed as a diagnosis, it should be suspected particularly in teenaged patients presenting with bilateral uveitis.

It affects both the kidneys and the eye. Most often the kidney disease starts first followed by recurrent episodes of uveitis affecting both eyes simultaneously.

Its cause is unknown and there is no known trigger as with most of the uveitis forms described so far. One report suggests the presence of a common abnormal antibody directed against ocular and renal proteins (renal tubular and ciliary body epithelium share several functions and may be the reason for this close association).

In this form of uveitis there is often found a higher level of beta 2 microglobulin in the urine and a higher incidence of HLA-DRB1*01 has been observed but a definitive diagnosis requires a kidney biopsy, which shows the presence of a tubulointerstitial nephritis with infiltration of mononuclear cells.

Luckily in most cases this uveitis responds well to local therapy or to relatively weak doses of immunosuppressive agents. Nevertheless, since it is a relatively rare disease, its long-term prognosis is still uncertain and an adequate follow-up is required.

What does a patient experience?

Vision gets blurry progressively over a few hours to days. There is increased sensitivity to light or sunshine, which is much worse than ever before. While it starts in one eye, it rapidly spreads to the other. It is often associated with a generalized sense of malaise - mild fever, weight loss, some aches and pains and if a GP does a urine analysis, this will shows some signs of being abnormal with the appearance of protein in much higher amounts as well as some blood. This is a sign of  kidney disease and is called a “nephritic” picture.

How should you be followed?

Since recurrences are frequent, it is important that you be periodically seen by an EyeMD. He can make sure that the inflammation you experience does not cause permanent damage to your eye. The inflammation itself is not dangerous, but the scar tissue that forms as a result of recurrent episodes of inflammation is what, in the long run, leads to vision loss.

Well-spaced visits allows the doctor to follow you in the long term and to adjust your medications according to your disease. This is the best way to prevent the damage of your eye and to diminish the risk of side effects of your medication.

Since the care needs to be individualized and is unique for each individual, it is not possible to propose here a general therapeutic scheme. We can only suggest that you be seen regularly and follow the advice of your treating EyeMD.