Tubulointerstitial nephritis and uveitis: association with suppressed cellular immunity

It is suggested that tubulointerstitial nephritis and uveitis (TINU) is a cell-mediated immune disease with a favourable response to treatment with steroids. However, long-term follow-up has not been described and data on immunological studies are limited. The aim of this study was to evaluate the clinical features in patients with TINU who have had a long follow-up period, and in parallel to assess their cellular immunity and HLA typing. Four women with TINU were followed for 5.7 +/- 3.6 years. On remission they were studied for T-cell-mediated immunity by skin tests, T-cell subpopulations, and lymphokine secretion in vitro. The lymphokines included interleukin-2, gamma-interferon, tumour necrosis factor, and colony-stimulating factor. The in vitro response to AS101, a previously described immunomodulator, was evaluated. HLA-typing was also performed. The nephritis, which occurred once, was resolved in all patients and did not recur. In contrast, numerous relapses of uveitis occurred despite topical or systemic steroid treatment. The patients' T-cell subpopulations did not differ from controls, but they revealed anergy to skin tests and a very low secretion rate of lymphokines. AS101 corrected the suppressed secretion in vitro. A high frequency of HLA-DR6 antigen was found in the TINU patients. TINU is probably a systemic disease with a chronic relapsing course of the uveitis but with complete clinical recovery of the nephritis. Both in vivo and in vitro T-cell functions are suppressed during remission.