Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Youlu Zhao; Junwen Huang; Tao Su; Zhikai Yang; Xizi Zheng; Liu Yang; Xujie Zhou; Xiaojuan Yu; Hui Wang; Suxia Wang; Gang Liu; Li Yang

doi:10.1159/000507668

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Kidney Dis (Basel). 2020 Nov;6(6):414-421. doi: 10.1159/000507668. Epub 2020 May 20.

Authors

Youlu Zhao^{1

2

3

4}, Junwen Huang^{1

2

3

4}, Tao Su^{1

2

3

4}, Zhikai Yang^{1

2

3

4}, Xizi Zheng^{1

2

3

4}, Liu Yang⁵, Xujie Zhou^{1

2

3

4}, Xiaojuan Yu^{1

2

3

4}, Hui Wang^{1

2

3

4

6}, Suxia Wang^{1

2

3

4

6}, Gang Liu^{1

2

3

4}, Li Yang^{1

2

3

4}

Affiliations

¹ Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
² Renal Pathology Center, Peking University Institute of Nephrology, Beijing, China.
³ Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
⁴ Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
⁵ Department of Ophthalmology, Peking University First Hospital, Beijing, China.
⁶ Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, China.

Abstract

Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU.

Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas.

Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.

Keywords: Acute kidney disease; Acute kidney injury; Acute tubulointerstitial nephritis; Thrombotic microangiopathy; Tubulointerstitial nephritis and uveitis.

Publication types

Review