Clinical Features and Outcomes of Tubulointerstitial Nephritis and Uveitis Syndrome in Spain and Portugal: The IBERTINU Project

ABSTRACT

Purpose

To assess the clinical features, management and prognosis of patients diagnosed with tubulointerstitial nephritis and uveitis (TINU) syndrome in Spain and Portugal.

Methods

Retrospective multicenter study, which included all patients diagnosed with TINU syndrome managed in 15 uveitis referral centers from Spain and Portugal.

Results

Forty-eight subjects with a mean age at diagnosis of 25.0 [14.8; 49.5] years were included. Both eyes were affected in 43 patients (89.6%). The visual outcome was favorable, but immunosuppressive systemic therapy (IST) was needed in 26 (54.16%) due to relapses. Renal function normalized in 35 patients (72.9%). HLA-DQB1*05 was the most common genetic typing (57.1%). The mean follow-up time was 22.5 [11.0; 48.0] months.

Conclusions

Both visual and renal outcomes were favorable, although IST was frequently used. TINU is under- diagnosed, so further prospective studies would provide more knowledge about its recognition and management.

Expert Opinion

TINU Syndrome is underdiagnosed because ocular and renal disease are asynchronous. Outcomes are favorable so it has to be highly suspected in cases of bilateral anterior uveitis. According to literature and our experience, systemic immunosuppressive therapy is often required because of ocular relapses.

This study adds to the previous knowledge that HLA-DQB1*05 could be an important HLA type amongst the TINU Syndrome Iberian population. HLA typing should be assessed in these patients in order to describe its phenotype-genotype relationship better. A considerable number of patients in our series were diagnosed in their sixties, so TINU Syndrome should also be suspected in elderly patients.

KEYWORDS:

• TINU
• uveitis
• nephritis
• cohort
• multicentric

Disclosure statement

Authors declare that there are not any competing financial interests in relation to the work described.

*Group information

The members of the IBERTINU study group are: Joseba Artaraz, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Ioana Ruiz-Arruza, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Carmen Pinedo, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Silvia Pérez-Fernández, Cruces University Hospital. Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Borja Santos-Zorrozua, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Aina Moll-Udina, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Maite Sainz-de-la-Maza, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Víctor Llorenç, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Alfredo Adan, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Gerard Espinosa, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Luis F. Quintana, Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Luís Figueira, Hospital S. João, University of Porto, Center for Drug Discovery and Innovative Medicines (MedInUP), Porto, Portugal; Ana C. Pedrosa, Hospital S. João, University of Porto, Center for Drug Discovery and Innovative Medicines (MedInUP), Porto, Portugal; Joana Araújo, Hospital S. João, University of Porto, Center for Drug Discovery and Innovative Medicines (MedInUP), Porto, Portugal; Marta Silva, Hospital S. João, University of Porto, Center for Drug Discovery and Innovative Medicines (MedInUP), Porto, Portugal; Ines Leal, Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa Lisbon, Portugal; Sofia Mano, Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa Lisbon, Portugal; Patricia José, Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa Lisbon, Portugal; Andrea Rouco, San Carlos Clinical University Hospital, Madrid, Spain; David Díaz-Valle, San Carlos Clinical University Hospital, Madrid, Spain; Ricardo Gómez, Central University Hospital of Asturias, Asturias, Spain; Miriam García, Central University Hospital of Asturias, Asturias, Spain; F. Samara Manrique, Central University Hospital of Asturias, Asturias, Spain; Vanesa Calvo-Río, Marqués de Valdecilla University Hospital, Santander, Spain; Marta Guedes, Egas Moniz Hospital, Lisboa, Portugal; Miguel Almeida-Cordeiro, Egas Moniz Hospital, Lisboa, Portugal; M. Paz Mendivil, Basurto University Hospital, Basque Country University UPV/EHU, Bilbao, Spain; Naroa Moreno, Basurto University Hospital, Basque Country University UPV/EHU, Bilbao, Spain; Ana Garrote, León University Hospital, León, Spain; Miguel Cordero-Coma, León University Hospital, León, Spain; Nieves Pardiñas, Miguel Servet University Hospital, Zaragoza, Spain; Ángela Gómez, Araba University Hospital, Basque Country University UPV/EHU, Vitoria-Gasteiz, Spain; Arantza Larrauri, Araba University Hospital, Basque Country University UPV/EHU, Vitoria-Gasteiz, Spain; Pilar Anaut, Araba University Hospital, Basque Country University UPV/EHU, Vitoria-Gasteiz, Spain; Saioa Eguiluz, Araba University Hospital, Basque Country University UPV/EHU, Vitoria-Gasteiz, Spain; Juan R. Dios, Araba University Hospital, Basque Country University UPV/EHU, Vitoria-Gasteiz, Spain; Gibet Benejam, Sant Joan de Reus University Hospital, Tarragona, Spain; Marc Baget, Sant Joan de Reus University Hospital, Tarragona, Spain; M José Capella, Barraquer Ophthalmology Center, Barraquer Ophthalmology Institute, Autonomous University of Barcelona, Barcelona, Spain; Ignacio Robles, Rey Juan Carlos University Hospital. Madrid, Spain; Ester Carreño, Rey Juan Carlos University Hospital. Madrid, Spain; Lena Giralt, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain; Alex Fonollosa, Lena Giralt, Cruces University Hospital, Basque Country University UPV/EHU, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain.

Additional information

Funding

This research has not received any governmental, non-governmental or non-profit entity support.