Abstract

SO.20.11

Tubulointerstitial nephritis and uveitis syndrome (TINU) is quite common in children with sudden onset, bilateral, anterior uveitis

Mackensen F.¹, David F.¹, Grulich-Henn J.², Becker M. D.^1
1Interdisziplinäres Uveitiszentrum, Augenklinik, ²Interdisziplinäres Uveitiszentrum, Klinik für Kinder- und Jugendmedizin, Universität Heidelberg

Objective: TINU is a specific form of uveitis that is unfamiliar to most ophthalmologists. The highest grade of certainty is gained by a positive kidney biopsy, a very invasive procedure. Urinary beta-2microglobulin (Ub2MG) is a marker for tubular dysfunction which has been shown to be elevated in in patients with TINU with normal renal function but abnormal renal biopsy (Goda et al). The aim of this study was to determine Ub2MG levels in children with bilateral, sudden onset anterior uveitis to screen for renal involvement.
Methods: Beginning January 2006 we obtained Ub2MG levels in all children (£18 years) with bilateral, sudden onset anterior uveitis attending our pediatric uveitis clinic for the first time. Other clinical criteria as defined by Mandeville et al were used to grade the certainty of the diagnosis. We compared with a healthy control group of children with strabismus and a group with other uveitis subsets.
Results: Ten children with bilateral, sudden onset anterior uveitis attended our clinic since January until 31.12.06 (total 59 new children). We tested nine for Ub2MG; one was excluded because he came with the certain diagnosis of TINU. Of these nine, 6 showed clinical criteria suggesting possible (n=4) to probable TINU (n=2). In all 6 patients Ub2MG levels were elevated to a mean value of 0.73 mg/l (SD=0.55). Conversely, the three patients without clinical criteria for TINU, all had normal Ub2MG levels (mean 0.16 mg/l, SD=0.08). There was a positive correlation between clinical criteria and Ub2MG levels (Spearman r=0.68, p=0.05). Ub2MG in 11 healthy children showed normal levels (M=0.25 mg/l, SD=0.13).
Conclusions: Our preliminary results indicate that TINU may be present in 60% (5+1/10) of children with bilateral, anterior sudden onset uveitis, and 10% (6/59) of all new children with uveitis seen in one year, by far a higher incidence than previously assumed. Ub2MG seems to be a non-invasive diagnostic marker to suggest the diagnosis of TINU.

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