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

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Alessia Paladini ◽  
Vittorio Venturoli ◽  
Giovanni Mosconi ◽  
Loretta Zambianchi ◽  
Luigi Serra ◽  
...  
Keyword(s):  
Plasma Cells ◽  
Tubulointerstitial Nephritis ◽  
Young Patients ◽  
Sudden Onset ◽  
Hla Typing ◽  
Ophthalmological Examination ◽  
Tinu Syndrome ◽  
History Of ◽  
Loss Of Appetite ◽  
Hla Dqa1

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.

scholarly journals Tubulointerstitial nephritis and uveitis (TINU) syndrome and recent Streptococcus infection in a 9-year-old girl

2020 ◽  
Vol 13 (2) ◽  
pp. e232077
Author(s):  
Robert BR Moreton ◽  
Brian W Fleck ◽  
Joyce Davidson ◽  
David Hughes
Keyword(s):  
Renal Function ◽  
Tubulointerstitial Nephritis ◽  
Sudden Onset ◽  
Outpatient Clinics ◽  
Glucocorticoid Treatment ◽  
Tinu Syndrome ◽  
Preserve Renal Function ◽  
Systemic Glucocorticoid ◽  
Clinical Investigations ◽  
History Of

A 9-year-old girl presented to hospital with a 6-week history of non-specific constitutional symptoms and weight loss. She initially underwent extensive medical investigation without diagnosis being achieved. Although raised inflammatory markers and impaired renal function were noted during her initial admission to hospital, it was her subsequent presentation 2 weeks later with sudden-onset bilateral anterior uveitis that prompted a renal biopsy that indicated acute tubulointerstitial nephritis. A diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was made and systemic glucocorticoid treatment initiated to prevent visual loss and preserve renal function. She has subsequently been reviewed in multidisciplinary outpatient clinics and treated with a tapering regimen of immunosuppressive therapy. Her treatment has been complicated by the side effects of glucocorticoids and by persistent relapses in ocular disease and abnormalities on urinalysis. Recent clinical investigations indicate that her uveitis is controlled and that renal function remains well preserved.

IgG4-related tubulointerstitial nephritis

2021 ◽  
Vol 14 (11) ◽  
pp. e241942
Author(s):  
Tasnim Momoniat ◽  
Deepa Jacob ◽  
Neelaveni Duhli ◽  
Tom Jorna
Keyword(s):  
Plasma Cells ◽  
Tubulointerstitial Nephritis ◽  
Epigastric Pain ◽  
Kidney Injury ◽  
Total Serum Protein ◽  
Total Serum ◽  
Immunoglobulin G4 ◽  
Igg4 Related Disease ◽  
History Of ◽  
Steroid Sensitive

A 67-year-old man was referred to the renal team following an episode of acute kidney injury on a background of chronic kidney disease. He had a 9-year history of steroid-sensitive arthritis, epigastric pain and isolated submandibular gland enlargement. He was noted to have a raised eosinophil count, total serum protein and total immunoglobulin G4 (IgG4) level as well as a serum hypocomplementaemia. A renal biopsy showed a tubulointerstitial nephritis with lymphoplasmacytic infiltrates, fibrosis and IgG4-positive plasma cells on immunohistochemistry. A diagnosis of IgG4-related disease was made based on clinical presentation and pathology. Renal function improved with glucocorticoids and the patient was successfully transitioned to azathioprine as a steroid-sparing agent.

Epiretinal membrane and cataract in a 5-year-old boy with the suspicion of neurofibromatosis type 2

Open Medicine ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Joanna Siwiec-Proscinska ◽  
Anna Gotz-Wieckowska ◽  
Marta Pawlak ◽  
Jaroslaw Kociecki
Keyword(s):  
Visual Acuity ◽  
Family History ◽  
Young Patients ◽  
Neurofibromatosis Type ◽  
Ophthalmological Examination ◽  
Neurofibromatosis 2 ◽  
Epiretinal Membranes ◽  
Negative Results ◽  
History Of ◽  
The Right

AbstractDifferent ocular findings have been described in association with neurofibromatosis 2 (NF2). Detailed ophthalmological examination of asymptomatic subjects with a family history of NF2 could help confirm the diagnosis in young patients. We present a case of unilateral cataract and bilateral epiretinal membranes in a 5-year-old boy with a family history of neurofibromatosis 2. The patient was referred to our department with diminished visual acuity bilaterally and an initial diagnosis of cataract in the right eye. Bestcorrected visual acuity was 3/19 in the right eye and 3/24 in the left eye (LH charts). On fundus examination, bilateral macular epiretinal membranes were found and confirmed by optical coherent tomography. In view of the ophthalmic signs mentioned above and the history of the patient’s father, who suffered from NF2 and died from meningioma and ependymoma, the patient was referred for genetic examination. Seventeen exons of the NF2 gene were tested with negative results. No pathology was found on clinical neurologic examination and magnetic resonance imaging of the brain. Although the patient has not met the criteria for NF2, he is now considered as an asymptomatic subject at risk and observed. Lens opacities with epiretinal membranes in children may be regarded as part of the clinical manifestation of NF2.

scholarly journals HIV Infection and Acute Stroke: A Case Report and a Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Hussein Assallum ◽  
Mohammad Alkayem ◽  
Nehad Shabarek
Keyword(s):  
Hiv Infection ◽  
Cardiovascular Events ◽  
Brain Mri ◽  
Young Patients ◽  
The United States ◽  
Sudden Onset ◽  
Endothelial Damage ◽  
Acute Infarction ◽  
History Of ◽  
The Relationship

Background. In the United States, ischemic stroke in HIV-infected patients has increased by 60%. However, unexpected cardiovascular events in relatively young patients have been observed.Clinical Vignette.A 31-year-old male who presented with a 5-hour history of sudden onset slurred speech and left hemiplegia. He has medical history of HIV infection for 2 years taking ARTs. On exam, a significant left hemiparesis was noticed. Brain MRI showed right anterior corona radiata and basal ganglia acute infarction.Discussion.Several mechanisms have been proposed for the relationship between HIV infection and cardiovascular risk. (i) HIV-associated dyslipidemia: HIV-infected patients tend to develop decrease in HDL-c and LDL-c levels. ART was associated with an increase in LDL-c but little change in HDL-c. (ii) Endothelial dysfunction: certain antiretroviral agents may independently contribute to endothelial damage. (iii) Hypertension: systolic blood pressure is higher in those using ART for greater than five years. (iv) Insulin resistance and diabetes have been noticed with ART. (v) Chronic inflammation. (vi) Hypercoagulability: decrease in proteins C and S was associated with HIV infection.Conclusion.Poorly controlled HIV infection and/or the introduction of ATR might be risk factors for cardiovascular events. More studies needed to address this medical dilemma.

scholarly journals Clinical and Genetic Features of Tubulointerstitial Nephritis and Uveitis Syndrome with Long-Term Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hiroaki Kanno ◽  
Kyoko Ishida ◽  
Wataru Yamada ◽  
Ikumi Shiraki ◽  
Hiroki Murase ◽  
...  
Keyword(s):  
Tubulointerstitial Nephritis ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Steroid Treatment ◽  
Hla Typing ◽  
Systemic Steroid ◽  
Long Term Follow Up ◽  
The Mean

Purpose. To investigate the clinical manifestations, prognosis, and HLA-type of tubulointerstitial nephritis and uveitis syndrome (TINU) with long-term follow-up. Methods. Clinical data of five patients with TINU were retrospectively reviewed. Results. The mean age was 15.8 years. The mean follow-up periods were 54.0 months. The initial subjective symptoms were bulbar injection (100%), ocular pain (80%), and blurred vision (60%). The medical department that the patients visited first was ophthalmology in 4 (80%) cases. Urinalysis showed the characteristic increase of the β2 microglobulin in all (100%) patients. Uveitis and nephritis were diagnosed within 1 week from each other. Although two showed recurrences, the topical and systemic steroid treatment with mean duration of 14.1 months brought the resolution of nephritis and uveitis in all patients. Recurrence-free periods ranged from 12 to 71 months. The final visual outcome was 20/20 or better in all cases. HLA-DR4 or the allele of DRB1∗04 was present in all (100%) patients. Conclusions. TINU should be considered in the differential diagnosis in young patients with uveitis of unknown origin and renal dysfunction. Urinary β2 microglobulin level and HLA typing may help in the diagnosis of TINU. The prognosis for patients with TINU is generally good with steroid treatment.

scholarly journals Tubulointerstitial Nephritis and Uveitis Syndrome—A Case Report and Review of Literature

2020 ◽  
Vol 5 (1) ◽  
pp. p27
Author(s):  
Hamzeh Mohammad Alrawashdeh, MD ◽  
Yazan Abu Gharbieh, MD ◽  
Omar Khalil Hamdan, MD ◽  
Mohammed Farah, MD
Keyword(s):  
Case Report ◽  
Interstitial Nephritis ◽  
Tubulointerstitial Nephritis ◽  
Pediatric Nephrology ◽  
Topical Steroid ◽  
Review Of Literature ◽  
Drug Induced ◽  
Tinu Syndrome ◽  
Rare Combination ◽  
History Of

A very little subset of patients diagnosed with interstitial nephritis have the tubulointerstitial nephritis and uveitis (TINU syndrome). A considerable number of cases have been documented in the pediatric nephrology and ophthalmology literature. We report a 12-year-old girl who presented with a history of allergic/drug-induced tubulointerstitial nephritis and diagnosed months later to have uveitis after stopping steroids. This considered a very rare combination and the diagnosis of tubulointerstitial nephritis and uveitis syndrome was established. She was treated successfully with topical steroid and topical cycloplegic agent for about 7 weeks. About 250 cases have been reported worldwide, and this is the first reported case in Jordan.

scholarly journals Blinding Bilateral Hyperviscosity Retinopathy in a 43-Year-Old Nigerian Male with Lymphoplasmacytic Lymphoma: A Case Report and Management Challenges

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Abdulkabir A. Ayanniyi ◽  
Uchenna Godswill Ejikeme ◽  
Yohanna Tanko ◽  
Rilwan C. Muhammad ◽  
Obiageli E. Nnodu
Keyword(s):  
Plasma Cells ◽  
Skin Lesions ◽  
Sudden Onset ◽  
Protein Electrophoresis ◽  
Visual Field Defects ◽  
Lymphoplasmacytic Lymphoma ◽  
Central Visual Field ◽  
Hand Motion ◽  
History Of ◽  
Made In

Lymphoplasmacytic lymphomas are rare and may present with uncommon and devastating symptoms. We report a case of a 43-year-old male who presented with bleeding gums and sudden onset of bilateral blindness but was not on anticoagulants and had no family history of bleeding disorder. He had bilateral hyperpigmented infraorbital skin lesions, visual acuities (VA) of hand motion in both eyes (blindness), round and sluggish pupils, and bilateral diffuse and extensive retinal haemorrhages obliterating the retinal details with central visual field defects. The optical coherence tomography revealed retinal haemorrhage, oedema, detachment, and diffuse photoreceptors damage. Investigations revealed elevated ESR andβ2microglobulin, monoclonal peak on serum protein electrophoresis, high IG with lambda restriction on serum, and urine immunofixation with increased lymphocytes and plasma cells in the bone marrow. A diagnosis of lymphoplasmacytic lymphoma complicated by blinding hyperviscosity retinopathy was made. In the absence of an aphaeresis machine, he received four cycles of manual exchange blood transfusion (EBT) and commenced with chlorambucil/prednisolone due to difficulty in obtaining blood for continued EBT. His general condition and VA has improved and he is stable for more than six months into treatment.

Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

2018 ◽  
Vol 69 (2) ◽  
pp. 375-378
Author(s):  
Catalin Pricop ◽  
Ileana Adela Vacaroiu ◽  
Daniela Radulescu ◽  
Daniel Andone ◽  
Dragos Puia
Keyword(s):  
Renal Impairment ◽  
Serum Creatinine ◽  
Young Patients ◽  
Kidney Injury ◽  
Contralateral Kidney ◽  
Reactive Protein ◽  
Ureteral Lithiasis ◽  
Unilateral Hydronephrosis ◽  
Duration Of Hospitalization ◽  
History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

scholarly journals Myocardial amyloidosis following multiple myeloma in a 38-year-old female patient: A case report

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 396-402
Author(s):  
Qisi Zhang ◽  
Yingli Qiao ◽  
Dongmei Yan ◽  
Yuhui Deng ◽  
Mengyang Zhang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Laboratory Data ◽  
Young Patients ◽  
Clinical Manifestations ◽  
The Elderly ◽  
First Episode ◽  
Rapid Progression ◽  
Congo Red Staining ◽  
Impaired Cardiac Function

AbstractMultiple myeloma (MM) is an immunoglobulin-producing tumor of plasma cells, which occurs commonly in the elderly. The incidence of myocardial amyloidosis with MM is extremely low and early clinical manifestations are nonspecific. The diversity of clinical manifestations and first episode symptoms often cause misdiagnosis in young patients with myocardial amyloidosis following MM. In this study, we analyzed the clinical data of a young woman with MM and impaired cardiac function combined with echocardiography, electrocardiography (ECG), laboratory data, cell Congo Red staining, and other manifestations to diagnose amyloidosis. Considering the rapid progression, short survival, and poor prognosis in most patients, a clear, definitive, and timely diagnosis is essential for the treatment of patients with MM complicated with myocardial amyloidosis.

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