Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome Sana Khochtali Imen Ksiaa Anis Mahmoud Bechir Jelliti Department of Ophthalmology Fattouma Bourguiba University Hospital Faculty of Medicine, University of Monastir, Monastir, Tunisia Ocular History - First Presentation 15-year-old girl OS : photophobia and tearing since 10 days Improvement of symptoms with topical steroids given by the parents Then also vision blurring, redness and photophobia of the OD June 2012 – First Presentation Visual acuity 20/50 OD, 20/40 OS Intraocular pressure : 19 mmHg OD, 16 mmHg OS No vitreous or vitreous haze OS Fundus examination : unremarkable OS OD granulomatous anterior uveitis with fibrinous exudate in the anterior chamber OS mild non –granulomatous anterior uveitis with extensive posterior synechiae Work-up Chest X-ray : unremarkable Tuberculin-skin test : negative Blood cell count : WBC count : 7700/mm3 Hb = 11 g/dl Syphilis serology : negative Anti-nuclear antibodies and antistreptolysine O antibodies : negative HLA B27 typing : negative First Diagnosis Idiopathic anterior uveitis Treatment: intensive steroid drops and ointment at bedtime (with progressive tapering), as well as mydriatics Follow up - Six weeks later fever, malaise, anorexia and diffuse arthralgia Work-up: renal insufficiency and proteinuria Renal biopsy: acute tubulointerstitial nephritis Ophthalmological examination: no clinical signs of active uveitis Laser flare values : 50 ph/ms OD and 46 ph/ms OS Final diagnosis Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome systemic prednisolone (starting dose of 1 mg/kg/day) maintained for 3 months Follow-up Four months after TINU syndrome diagnosis, Recovery of the renal function Visual acuity : 20/25 OD and 20/32 OS, flare within normal limits Slit-lamp photographs show posterior synechiae , that are more prominent in the left eye Conclusions Although TINU syndrome is a rare cause of uveitis, it should be highly suspected in patients with bilateral anterior uveitis of sudden onset who are younger than 20 years. Urinalysis should be performed in such patients Uveitis may occur at the same time of, before or after nephritis Conclusions Systemic steroids are usually prescribed to treat renal disease. However, they may be required to control anterior uveitis if unresponsive to topical steroids A close monitoring is helpful for timely detection of recurrences of ocular inflammation or insidious chronic anterior uveitis Posterior synechia are a common complication of TINU syndrome-associated anterior uveitis