Tubulointerstitial Nephritis with Uveitis in Chinese Adults
Tubulointerstitial Nephritis with Uveitis in Chinese Adults
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DOI：
10.2215/cjn.02540313
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发表时间：
2014-01-07
影响因子：
9.8
通讯作者：
Yang, Li
中科院分区：
文献类型：
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作者：
Li, Cui;Su, Tao;Yang, Li
肾小管间质性肾炎和葡萄膜炎（TINU）综合征是急性肾小管间质性肾炎（ATIN）的一种罕见病因，常伴肾脏恢复。本研究旨在调查TINU综合征的诊断，预后和影响因素，采用前瞻性follow-up.Design，setting，participants，& measurementsThis study纳入了2007年至2012年ATIN患者前瞻性队列中的TINU综合征患者。在活检时收集临床病理数据，并测量抗修饰C反应蛋白（mCRP-Ab）的自身抗体。同时检测血清和肾组织中Kreb von den Lunge-6的表达。独立的危险因素，在12个月和迟发性葡萄膜炎肾预后不良进行了analysed.Results31例（28%）活检证实ATIN被归类为TINU综合征。在这些患者中，18例（58%）发生迟发性葡萄膜炎，并在活检时被误诊为药物诱导的ATIN。mCRP-Ab水平异常是迟发性葡萄膜炎的独立风险因素（比值比，14.7; 95%置信区间，3.4 - 64.0）。TINU综合征和药物诱导的ATIN患者血清和肾组织中的Kreb von den Lunge-6水平相当。92%的患者在活检后12个月发生3-4期CKD和/或肾小管功能障碍。年龄、血清肌酸水平、红细胞沉降率、合并甲状腺疾病或白细胞尿与肾脏预后不良相关。复发是在36%（11的31）的患者和强化不良肾outcome.ConclusionsThe诊断TINU综合征可以错过了一个很大的分数与ATIN患者，因为葡萄膜炎可以提出以及发病后的肾小管间质性肾炎。升高的mCRP-Ab水平可能有助于预测迟发性葡萄膜炎TINU综合征。不幸的是，TINU患者往往有频繁的复发，大多数患者有不完全的肾脏恢复。需要长期随访以防止误诊和正确处理TINU综合征。
Background and objectivesTubulointerstitial nephritis and uveitis (TINU) syndrome is considered a rare cause of acute tubulointerstitial nephritis (ATIN) that is usually associated with renal recovery. This study sought to investigate the diagnosis, prognosis, and contributing factors of TINU syndrome using a large cohort of patients with prospective follow-up.Design, setting, participants, & measurementsThis study included patients with TINU syndrome from a prospective cohort of patients with ATIN from 2007 to 2012. Clinical-pathologic data were collected at biopsy and autoantibodies against modified C-reactive protein (mCRP-Ab) were measured. Serum levels and renal tissue expression of Kreb von den Lunge-6 were also detected. Independent risk factors for poor renal outcome at 12 months and late-onset uveitis were analyzed.ResultsThirty-one patients (28%) with biopsy-proven ATIN were classified as having TINU syndrome. Of these patients, 18 (58%) developed late-onset uveitis and were misdiagnosed as having drug-induced ATIN at the time of biopsy. An abnormal level of mCRP-Ab was an independent risk factor for late-onset uveitis (odds ratio, 14.7; 95% confidence interval, 3.4 to 64.0). Patients with TINU syndrome and drug-induced ATIN had comparable levels of Kreb von den Lunge-6 in both serum and renal tissues. Ninety-two percent of patients developed stage 3-4 CKD and/or tubular dysfunction by 12 months postbiopsy. Age, serum creatine level, erythrocyte sedimentation rate, and the presence of concomitant thyroid disease or leukocyturia were related to poor renal outcome. Relapse was seen in 36% (11 of 31) of patients and potentiated poor renal outcome.ConclusionsThe diagnosis of TINU syndrome can be missed in a large fraction of patients with ATIN because uveitis can present well after the onset of tubulointerstitial nephritis. Elevated mCRP-Ab levels may be useful in predicting late-onset uveitis TINU syndrome. Unfortunately, patients with TINU tended to have frequent relapses and most patients had incomplete renal recovery. Long-term follow-up is needed to prevent misdiagnosis and properly manage TINU syndrome.