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Case Reports in Pediatrics
Volume 2013, Article ID 652043, 4 pages
http://dx.doi.org/10.1155/2013/652043
Case Report

Tubulointerstitial Nephritis and Uveitis Syndrome in a Twelve-Year-Old Girl

1Department of Pediatrics, G.B. Morgagni-L. Pierantoni Hospital, AUSL Forlì, Via Carlo Forlanini 34, 47100 Forlì, Italy
2Pediatric Clinic, University of Ferrara, 44121 Ferrara, Italy
3Department of Nephrology, G.B. Morgagni-L. Pierantoni Hospital, AUSL Forlì, Forlì, Italy
4Department of Anatomical Pathology, G.B. Morgagni-L. Pierantoni Hospital, AUSL Forlì, Forlì, Italy

Received 28 February 2013; Accepted 1 April 2013

Academic Editors: C. Aldana-Valenzuela, B. Das, and G. Singer

Copyright © 2013 Alessia Paladini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disorder defined by the combination of biochemical abnormalities, tubulointerstitial nephritis, and uveitis. We describe a 12-year-old female, presented with a ten-day history of fever, characterized by sudden onset and rapid spontaneous resolution in few hours, accompanied by shivering, extreme fatigue, and loss of appetite. Laboratory values were consistent with renal failure of tubular origin. Renal biopsy confirmed a tubulointerstitial nephritis, with acute tubulitis, polymorphonuclear infiltration, and microabscesses. The renal interstitium was occupied by a dense inflammatory infiltrate, consisting of lymphocytes, plasma cells, and neutrophils. Glomerular structures were preserved. Ophthalmological examination that suggested a previous asymptomatic bilateral uveitis and HLA typing (HLA-DQA1*0101/0201 and HLA-DQB1*0303/0503) further supported the suspect of TINU syndrome. TINU syndrome is probably an underdiagnosed disorder, responsible for many cases of idiopathic anterior uveitis in young patients, especially in those who have asymptomatic renal disease and when proper diagnostic tests are not performed at the time of presentation.