Successful long-term treatment of tubulointerstitial nephritis and uveitis with mycophenolate

Tubulointerstitial nephritis and uveitis (TINU) syndrome is characterised by bilateral anterior uveitis and acute kidney injury secondary to interstitial nephritis. Corticosteroids remain the cornerstone of therapy. There is little data around the use of steroid-sparing agents.We present a female in her sixth decade of life of Caucasian ethnicity who presented with acute kidney failure requiring dialysis from TINU. Systemic corticosteroids were commenced; however, she developed a cushingoid appearance, proximal myopathy and hyperglycaemia. Mycophenolate mofetil was initiated as a steroid-sparing agent with significant improvement in kidney function. She remains well 2.5 years later. Incidentally, she was noted to have a distant history of vulval sarcoidosis without any other evidence of active disease on imaging and a normal serum angiotensin-converting enzyme.This case demonstrates successful long-term outcomes of mycophenolate in the management of TINU.