Possible Tubulointerstitial Nephritis and Uveitis (TINU) syndrome

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare form of ocular inflammation, with the only systemic manifestation being acute interstitial nephritis. We report a case of TINU that presented with ocular abnormalities after being diagnosed with interstitial nephritis. Our patient had an initial presentation of fever with chills and weakness at the time of presentation to their nephrologist. Blood investigations revealed elevated creatinine, proteinuria and increased β2 microglobulin, following which they were diagnosed with possible TINU syndrome as per Mandeville's diagnostic criteria. Our patients responded well to oral and topical steroids. She had recurrent episodes, which were subsequently managed. It is important to have a high index of suspicion for TINU as patients, even in the absence of a renal biopsy, as they have an excellent prognosis with timely treatment. TINU is a rare diagnosis and is most likely because it is often missed. However, patients with TINU syndrome require a customized multispecialty approach in order to diagnose, rule out other causes of uveitis and AIN and hence manage appropriately.