TUBULOINTERSTITIAL NEPHRITIS AND UVEITIS SYNDROME-A CASE REPORT/TUBULOINTERSTICIJALNI NEFRITIS I UVEITIS SINDROM-PRIKAZ SLUCAJA

• Published in: Medicinski pregled Vol. 74; no. 5-6; p. 183
• Main Authors: Kovac, Natasa, Kovac, Maja, Lukic, Maja Samardzic, Stajic, Natasa, Milosevic, Biljana
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01-05-2021
• Subjects: Chronic kidney failure; Corticosteroids; Development and progression; Diagnosis; Diseases; Health aspects; Immune response; Mediation; Nephritis; Uveitis
• ISSN: 0025-8105
• DOI: 10.2298/MPNS2106183K

Introduction. Tubulointerstitial nephritis and uveitis syndrome is a rare oculo-renal disease characterized by the presence of bilateral, anterior uveitis and tubulointerstitial nephritis. The pathogenesis of this disease is still not completely clear. It is associated with prior drug use, infections and autoimmune diseases. The involvement of the cellular and humoral immune responses and genetic predisposition to the development of this syndrome are frequently mentioned in the literature. In a certain number of cases, despite extensive diagnostics, the cause remains unknown (idiopathic tubulointerstitial nephritis and uveitis syndrome). Case Report. A fifteen-year-old female patient was admitted to the Department of Nephrology due to complaints of headache in the temples that occasionally occurred in the previous months. Three days before admission, the patient presented with symptoms of upper respiratory tract infection and subfebrile temperature (to 37.8 (o) C). Laboratory test results revealed the development of acute tubulointerstitial nephritis, and in the fifth week of the disease, bilateral anterior uveitis was detected. The diagnosis was confirmed by percutaneous kidney biopsy. Systemic and local corticosteroid therapy was introduced, and after a month it resulted in gradual normalization of kidney function, proteinuria reduction and withdrawal of the ophthalmic symptoms. Conclusion. Due to the fact that kidney damage is often self-limited and that uveitis tends to be recurrent, there is a high probability of untimely diagnosis. Early recognition, detection of potential causes and initiation of treatment, are crucial in the prevention of disease progression and development of chronic sequelae such as chronic renal failure and chronic uveitis. Key words: Nephritis, Interstitial; Uveitis; Early Diagnosis; Signs and Symptoms; Biopsy; Prednisolone; Kidney Function Tests; Eye Diseases Uvod. Tubulointersticijalni nefritis i uveitis sindrom je retko okulo-renalno oboljenje koje karakterise prisustvo obostranog, prednjeg uveitisa i tubulointersticijalnog nefritisa. Patogeneza oboljenja nije jos uvek sasvim jasna. Povezuje sa sa prethodnim koristenjem lekova, infekcijom i autoimunim bolestima. Sve vise se govori i o ucestvovanju celularnog i humoralnog imu-noodgovora i genetskoj predispoziciji za razvoj ovog sindroma. Odreden broj slucajeva i pored opsezne dijagnostike ostaje bez poznatog uzroka (idiopatski tubulointesticijalni nefritis i uveitis sindrom). Prikaz slucaja. Pacijentkinja uzrasta 15 godina, primljena je na Odeljenje nefrologije sa podacima o glavobolji u slepoocnom predelu koja je povremeno bila prisutna prethod-nih nekoliko meseci. Tri dana pre prijema u bolnicu, javili su se simptomi infekcije gornjih disajnih puteva i supfebrilnost do 37,8[degrees] C. Uradeni laboratorijski nalazi su ukazivali na razvoj akutnog tubulointersticijalnog nefritisa, a pete nedelje bolesti potvrdeno je prisustvo obostranog prednjeg uveitisa. Dijagno-za je potvrdena perkutanom biopsijom bubrega. Uvedena je terapija sistemskim i lokalnim kortikosteroidima, na ciju pri-menu vec u prvom mesecu dolazi do postepene normalizacije bubrezne funkcije, negativizacije proteinurije i povlacenja of-talmoloskih simptoma. Zakljucak. S obzirom da je bubrezno ostecenje cesto samoogranicavajuce i da uveitisi imaju tenden-ciju povlacenja i ponovnog javljanja, postoji velika mogucnost nepravovremene dijagnoze. Rano prepoznavanje, otkrivanje potencijalnih uzroka i zapocinjanje lecenja je kljucno u preven-ciji progresije bolesti i nastanka hronicnih sekvela kao sto su razvoj hronicne bubrezne insuficijencije i hronicnog uveitisa. Kljucne reci: intersticijalni nefritis; uveitis; rana dijagnoza; znaci i simptomi; biopsija, prednizon; testovi bubrezne funkcije; bolesti oka