Tubulointerstitial nephritis and uveitis syndrome: an unexpected diagnosis

A male in his 50s presented to the renal department with a diagnostic challenge of an unexplained kidney injury. Antiphospholipid antibody syndrome and oral anticoagulation augmented the risk for a renal biopsy. This, along with relatively static estimates of glomerular filtration rate combined to delay renal biopsy and definitive renal diagnosis by 6 months. The late emergence of symptomatic bilateral anterior uveitis consolidated the diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome but it also highlighted a lack of systemic early screening for ocular disease in the renal clinic. When faced with a diagnostic challenge, clinicians are more likely to find clinical conditions they are actually looking for. Increased awareness of TINU, earlier screening for ocular symptoms at presentation and/or examination for asymptomatic uveitis when a diagnosis of tubulointerstitial nephritis is being considered is recommended. Furthermore, early screening in cases of bilateral anterior uveitis for existing kidney issues should be pursued.