Long-term outcome of biopsy-proven idiopathic tubulointersitial nephritis with or without uveitis in children : a nationwide follow-up study
Rytkönen, Sari; Tainio, Juuso; Saarela, Ville; Endén, Kira; Kataja, Janne; Arikoski, Pekka; Nuutinen, Matti; Jahnukainen, Timo (2021-05-18)
Rytkönen, S., Tainio, J., Saarela, V. et al. Long-term outcome of biopsy-proven idiopathic tubulointersitial nephritis with or without uveitis in children—a nationwide follow-up study. Pediatr Nephrol 36, 3663–3671 (2021). https://doi.org/10.1007/s00467-021-05060-5
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https://urn.fi/URN:NBN:fi-fe2021111054603
Tiivistelmä
Abstract
Background: Only a few studies reporting the long-term outcome of children with idiopathic tubulointerstitial nephritis (TIN) and uveitis syndrome (TINU) are available. We studied the long-term kidney and ocular outcome in a nationwide cohort of children with TIN or TINU.
Methods: All patients followed up for a minimum of 1 year by a paediatrician and an ophthalmologist were enrolled. The data on plasma creatinine (P-Cr), estimated glomerular filtration rate (eGFR), proteinuria, hypertension and uveitis were collected retrospectively.
Results: Fifty-two patients were studied. Median age at time of diagnosis was 13.1 (1.8–16.9) years and median follow-up time was 5.7 (1.1–21.2) years. Forty-five (87%) patients were initially treated with glucocorticoids. The median of the maximum P-Cr was 162 μmol/l (47–1,016) and that of eGFR 47 ml/min/1.73m² (8–124). Uveitis was diagnosed in 33 patients (63%) and 21 (40%) patients developed chronic uveitis. P-Cr normalised in a median of 2 months. Eleven (21%) patients had nephritis recurrence during or after discontinuation of glucocorticoids. At the latest follow-up, 13 (25%) patients had eGFR < 90 ml/min/1.73m² (median 83; 61–89 ml/min/1.73m²). Six patients had tubular proteinuria; all presented with TIN without uveitis. Seven (13%) patients were hypertensive. Eleven (21%) patients had uveitis. One patient developed uraemia and was later transplanted.
Conclusions: Our study questions the previously reported good long-term kidney and ocular outcome of patients with TIN/TINU. Decreased kidney function and/or ocular co-morbidities may persist for several years; thus, both kidney and ocular follow-up for at least 1 year is warranted.
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