Acute tubulointerstitial nephritis (ATIN) is a unique form of interstitial nephritis that is responsible for approximately 15% of the cases with renal failure. Mostly, ATIN begin when certain medications, infections (such as Chlamydia and Epstein Barr virus), autoimmune diseases, and other factors cause an immune-mediated tubulointerstitial injury. Patients often present with fever, rash, dehydration, enlarged kidneys, uveitis, and arthralgias. The median age of patients with ATIN is found to be 15 years and most patients are adolescents and young women. The disease affects females more than males with the ratio 2-3:1. The best diagnostic method for ATIN is renal biopsy examination. Corticosteroids have provided some benefits to the patients; however, nephrectomy would be the only choice in advanced cases.
Hamdan and Obeidat (2006) reported the case of a 6-year-old boy with tubulo-interstitial nephritis and uveitis (TINU) syndrome. He presented with a 4-month history of anorexia, weight loss and fatigue. After 2 months of corticosteroid therapy, resolution of the uveitis was almost complete but renal function showed only partial improvement. He was still in renal failure 6 months after diagnosis, but there was no relapse of the uveitis.
Mortajil et al., 2006 reported two female patients with severe renal failure of acute onset with the first patient requiring hemodialysis. Acute tubulointerstitial nephritis was diagnosed in both cases and both patients were started on oral steroids at a dose of 1 mg/kg/day. Progressive improvement in renal function was noticed in both patients. The patients presented with bilateral anterior uveitis three months later, which required local corticosteroid therapy. The cause of the interstitial nephritis and the uveitis was unclear in both the cases. Normal renal function was restored in these patients after 24 and 27 months of follow-up, respectively.
Ben Hamida et al. (1995) report the case of a 35-year-old man who was admitted to the hospital for acute renal failure, arthralgia and anterior uveitis. The infectious and the immunological investigations were negative. The ocular examination shows bilateral anterior uveitis. The renal biopsy revealed acute tubulo-interstitial nephritis. He was treated by prednisone (0.5 mg/Kg/day) and subsequently his clinical course was favorable.