Presence of autoantibodies against tubular and uveal cells in a patient with tubulointerstitial nephritis and uveitis (TINU) syndrome

Tubulointerstitial nephritis and uveitis (TINU) syndrome is characterized by acute tubulointerstitial nephritis with a favourable course and chronic recurrent uveitis. Since the first description in 1975 [1], more than 150 cases have been described in the literature [2]. Most of the patients with TINU syndrome are adolescents and young women, with a median age of onset of 15 (range 9 to 74) years. Renal tubulointerstitial infiltrates are primarily composed of activated lymphocytes, among which the helper/inducer T-cell subset is reported to be predominant [3,4]. In addition, TINU syndrome can be associated with granuloma in kidney or in another localization like bone marrow [1,5–7]. The pathogenesis of TINU syndrome remains unclear, but cell-mediated immunity, in particular delayed-type hypersensitivity, could play a large role in this disorder [8]. In addition, some studies suggest that uveitis and tubulointerstitial nephritis have a common immunological pathogenesis and so it was postulated that there may be a common antigenicity between renal and ocular tissues [3,9]. We report the first case of TINU syndrome associated with autoantibodies reacting to a possible common renal tubular and uveal antigen in a context of granulomatous inflammation.