Tubulointerstitial Nephritis and Uveitis Syndrome in Children: A Prospective Multicenter Study

• Published in: Ophthalmology (Rochester, Minn.) Vol. 120; no. 7; pp. 1476 - 1481
• Main Authors: Saarela, Ville, MD, PhD, Nuutinen, Matti, MD, PhD, Ala-Houhala, Marja, MD, PhD, Arikoski, Pekka, MD, PhD, Rönnholm, Kai, MD, PhD, Jahnukainen, Timo, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2013
• Subjects: Adolescent; Age of Onset; Biopsy; Child; Child, Preschool; Double-Blind Method; Female; Glucocorticoids - therapeutic use; Humans; Male; Nephritis, Interstitial - complications; Nephritis, Interstitial - diagnosis; Nephritis, Interstitial - drug therapy; Ophthalmology; Prednisone - therapeutic use; Prospective Studies; Syndrome; Treatment Outcome; Uveitis - complications; Uveitis - diagnosis; Uveitis - drug therapy
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2012.12.039

Purpose To evaluate the occurrence and characteristics of uveitis related to tubulointerstitial nephritis (TIN) in children. Design Prospective, observational, multicenter, partly placebo-controlled treatment trial. Participants Nineteen children with a biopsy-proven TIN. Methods Patients were treated with prednisone or followed without treatment. In addition to the nephrologic evaluations, the prospective follow-up included structured ophthalmological examinations at the onset of TIN and at 3 and 6 months after the diagnosis. Main Outcome Measures Occurrence, clinical features, and outcome of uveitis. Results Some 84% (16/19) of the patients had uveitis, 83% (5/6) in the nontreatment group and 82% (9/11) in the prednisone-treated group. The remaining 2 patients, originally in the nontreatment group, were switched to the prednisone group after 2 weeks. Both of them developed uveitis. Altogether, 3 patients developed uveitis during prednisone treatment and 2 patients showed worsening of uveitis despite the systemic corticosteroid. Some 50% (8/16) of the patients with uveitis presented with no ocular symptoms; 88% (14/16) of the patients had a chronic course of uveitis. Two patients were diagnosed with uveitis before nephritis; nephritis and uveitis were diagnosed within 1 week from each other in 7 patients, and uveitis developed 1 to 6 months after the diagnosis of TIN in 7 patients. Conclusions There was no statistically significant difference in the occurrence of uveitis in patients with TIN in the prednisone and nontreatment groups. In this study, the occurrence of uveitis associated with TIN was considerably higher than previously reported. Uveitis related to TIN may develop late and is often asymptomatic. The ophthalmological follow-up of all patients with TIN is warranted for at least 12 months starting with 3-month intervals. Financial Disclosure(s) The authors have no proprietary or commercial interest in any material discussed in this article.