This protocol addresses patients with tubulointerstitial nephritis and uveitis (TINU) syndrome in whom the renal component — tubulointerstitial nephritis — drives the clinical concern. In this scenario, the uveitis does not independently require systemic treatment, yet the renal inflammation may still demand systemic intervention to prevent progressive kidney damage.
Tubulointerstitial nephritis with no ocular indication for systemic therapy. Despite the absence of an ophthalmic driver for escalation, the renal disease in TINU syndrome can warrant systemic treatment in its own right.
The protocol involves a systemic approach — directed at controlling renal inflammation — for patients in this specific situation. The complete regimen, therapeutic sequence, and decision thresholds are available in the full protocol.
Treatment targets improvement in urinary β2-microglobulin levels and resolution of renal inflammatory signs. Timely intervention is associated with meaningful differences in renal outcomes.
DOI: 10.1097/ICU.0b013e3283318f9a
In the absence of an ocular indication for systemic therapy, some patients will still require systemic corticosteroids or immune modulation for their renal disease.
In one series, prompt corticosteroid therapy greatly improved short-term urinary b2-microglobulin levels and inflammatory signs on repeat biopsy in three patients, whereas a fourth patient with delayed treatment demonstrated persistent elevations in b2-microglobulin and renal inflammation, with subsequent permanent renal damage.