AM Report 12/07/16 TINU

Remember that red eye with WARNING symptoms like loss of visual acuity, ophthalmoplegia, pupillary involvement, photophobia, diplopia,  associated systemic symptoms 

Signs and Symptoms of Uveitis 

Exam: can see ciliary flush (circumcorneal injection), hypopyon (not specific, can be seen in many other eye conditions), redness at the limbus
Discharge: MINIMAL
Pupil: often constricted
Ocular pain: moderate to severe, deep aching pain
Vision: mild-moderately reduced
Cornea: often hazy in appearance
Treatment: Steroids

Etiology of Uveitis 

IDIOPATHIC (most common)
-Trauma
-Infectious (HSV, Zoster, Toxo, Syphillis, TUBERCULOSIS, West-Nile, cat-scratch disease)
-Sarcoidosis
-Vasculitis
-Spondyloarthropathies
-SLE/Sjogrens

AIN (Acute interstitial nephritis) 
Keep AIN in your differential for new onset AKI, especially if on antibiotics or NSAIDS!

Etiologies of AIN

1)Drugs (LOTS of them, commonly cephalosporins, NSAIDS, but includes famotidine, omeprazole)
2)Infections (Leptospira, legionella, staph, strep, etc.)
3)Sarcoidosis
4)Sjogrens syndrome
5)TINU
Many other immune and neoplastic disorders!

TINU (Tubulointerstitial nephritis and uveitis) 

RARE disease, ~250 cases since 1976
-Pathogenesis thought to be due to auto-immune T cell mediated with common modified C-reactive protein in both the uvea and renal tubular cells
Manifests as Uveitis and Interstitial Nephritis, however must RULE out other etiologies of uveitis and AIN, especially Sarcoidosis and Sjogren’s as can look very similar.
Treatment: Steroids, usually 1 mg/kg/day  (40-60 kg) for 3-6 months

 

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