Eye examination is important in patients with tubulointerstitial nephritis

Abstract

Sirs,Dr. Lava and his colleagues present the interesting case of apatient with idiopathic tubulointerstitial nephritis (TIN) andlate-onset uveitis [1]. The authors highlight the importanceof ophthalmologic follow-up in TIN patients, and their casedemonstrates that uveitis may develop in a patient evenduring ongoing corticosteroid therapy. In our study [2],uveitis was diagnosed in five patients between 3 and15 months after onset of nephritis, i.e., in 42% of the patientswith TIN and uveitis. Two of these patients were not receivingany medication at the time uveitis was diagnosed, threepatients were on corticosteroids (0.15 –0.65 mg/kg/day), withone also on cyclosporin A.The case report by Dr. Lava et al. as well as our ownexperience suggest that uveitis may develop in TIN patientsduring the weaning of systemic corticosteroid treatment.Uveitis may be asymptomatic and, therefore, ophthalmologicslit lamp examination should be performed before thecorticosteroid dose is reduced. If necessary, topical treatmentshould be started in order to avoid long-term eye complica-tions.Theophthalmologicalfollow-upofbothTINandTINUpatients for at least 12 months is motivated by three factors:(1) uveitis may develop late and be asymptomatic; (2) uveitismay relapse afterapparenthealing;(3)uveitis may turnout tobe chronic.References