Tubulointerstitial Nephritis with Uveitis



Tubulointerstitial Nephritis with Uveitis


A. Brad Farris, III, MD










Hematoxylin & eosin shows a diffuse interstitial infiltrate with interstitial fibrosis and tubular atrophy in a case of tubulointerstitial nephritis with uveitis (TINU).






Periodic acid-Schiff stain shows a tubulointerstitial nephritis with a focus of tubulitis image in a case of TINU.


TERMINOLOGY


Abbreviations



  • Tubulointerstitial nephritis with uveitis (TINU)


Synonyms



  • Dobrin syndrome


Definitions



  • Tubulointerstitial nephritis associated with uveitis and, in some cases, identifiable bone marrow granulomas


ETIOLOGY/PATHOGENESIS


Environmental Exposure



  • Environmental exposures such as insect bites have been proposed in selected cases


Infectious Agents



  • A few of the multiple suggested associated pathogens include: Klebsiella, Chlamydia, Mycoplasma, herpes zoster, Epstein-Barr virus (EBV), and Toxoplasma


Autoimmune



  • Most likely cause in most cases


  • Lymphocyte reactions and circulating antibodies to renal tubular epithelia


  • Antibodies may also be directed against uveal cells


Genetic



  • Reports of identical twins and siblings with identical haplotypes suggest genetic predisposition


CLINICAL ISSUES


Epidemiology



  • Incidence



    • ˜ 5% of lymphocytic interstitial nephritis cases


  • Age



    • Mostly adolescents



      • Median age of onset 15 years; range: 9-74 years


      • First 2 patients were Caucasian females, 14 and 17 years old, respectively (Dobrin, 1975)


  • Gender



    • F > M


Presentation

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Tubulointerstitial Nephritis with Uveitis
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