Diagnostic Criteria for the Tubulointerstitial Nephritis and Uveitis Syndrome

 

Parameters:

(1) histopathologic criteria for tubulointerstitial nephritis

(2) clinical criteria (complete or incomplete) for tubulointerstitial nephritis

(3) uveitis characteristics

(4) another systemic disease capable of causing either uveitis or interstitial nephritis

Tubulointerstitial Nephritis Criteria	Uveitis	Another Diagnosis	Diagnostic Category
histopathologic	typical	absent	definite
clinical complete	typical	absent	definite
histopathologic	atypical	absent	probable
clinical incomplete	typical	absent	probable
clinical incomplete	atypical	absent	possible

 

Criteria for typical uveitis:

(1) bilateral anterior uveitis with or without intermediate uveitis or posterior uveitis

(2) onset of uveitis <= 2 months before OR <= 12 months after acute interstitial nephritis

 

Criteria for atypical uveitis:

(1) unilateral anterior uveitis OR intermediate uveitis OR posterior uveitis

(2) onset of uveitis > 2 months before OR > 12 months after acute interstitial nephritis

 

Histopathologic criteria:

(1) renal biopsy histology consistent with tubulointerstitial nephritis

 

Clinical criteria:

(1) abnormal renal function (elevated serum creatinine, decreased creatinine clearance)

(2) abnormal urinalysis with increased beta-2-microglobulin, low grade proteinuria, urinary eosinophils, pyruria or hematuria without infection, urinary white cell casts, normoglycemic glucosuria

(3) a systemic illness lasting >= 2 weeks, with a combination of fever, weight loss, malaise, fatigue, rash, abdominal pain, flank pain, arthralgias, myalgias, anemia, abnormal liver function tests, eosinophilia, elevated ESR (> 40 mm in first hour)

 

Low grade proteinuria is indicated by one of the following:

(1) 1+ or 2+ urinary protein on semi-quantitative test

(2) spot urinary protein to urinary creatinine ratio < 3

(3) 24 hour urine protein with < 3.0 grams in an adult or < 3.5 grams per 1.73 meter square BSA in child

 

If all 3 criteria are present, then the clinical criteria are complete.

 

If 1 or 2 of the criteria are present, then the clinical criteria are incomplete.