We report a case of idiopathic tubulointerstitial nephritis associated with bilateral uveitis(TINU syndrome) in an elderly lady,who with non-specific systemic associations developed acute renal failure,is described to increase awareness of the condition and also suggest a change in The Royal College of Ophthalmologists guidelines on Investigation of patients with Uveitis'.KEYWORDS: Idiopathic tubulointerstitial nephritis associated with bilateral uveitis; renal failure; guidelines; uveitis

Sarcoidosis is a rare and potentially disabling disease in the paediatric age group. Clinical management of such cases is difficult and requires long-term monitoring. We report a case of a 9 years old Caucasian girl who presented initially with bilateral chronic anterior uveitis, cataracts and glaucoma secondary to sarcoidosis. She was treated with Guttae Levobunolol, topical and systemic steroids over the last 2 years but subsequently required cataract extractions with foldable intraocular lens uveitis was well controlled with both topical steroids and low dose methotrexate over the last 2 months following cataract surgery. Her full blood counts and renal functions are monitored regularly. There was no adverse effect from the methotrexate reported so far. Sarcoidosis is a multisystem disease and requires multi-disciplinary input from ophthalmologists, neurologists and paediatricians. Medical and surgical treatment of such ocular manifestations is challenging. This case highlights both the safety of low dose methotrexate in the management of childhood chronic uveitis and the need for prompt treatment in such cases to avert significant morbidity from this disease.