clozapine and Acute-Kidney-Injury

Tubulointerstitial nephritis is a common cause of acute renal failure, in two thirds of cases it is associated with drugs (mostly antimicrobials and NSAIDs), in 5-10% of cases it is associated with infections (bacterial/viral/parasitic), in 5-10% of cases it is idiopathic (this is the case of the TINU syndrome characterized by interstitial nephritis and bilateral uveitis, and the anti-glomerular basal membrane antibody syndrome), and finally in 10% of cases it is associated with systemic diseases (sarcoidosis, by Sjogren, LES). The pathogenesis is based on a cell-mediated immune response and in most cases removing the causative agent is the gold standard of therapy. However, a percentage of patients, in a variable range from 30% to 70% of cases, do not fully recover renal function, due to the rapid transformation of the interstitial cell infiltrate into vast areas of fibrosis. Clozapine is a second generation atypical antipsycothic usually used for the treatment of schizophrenia resistant to other types of treatment; it can cause severe adverse effects among which the best known is a severe and potentially fatal neutropenia, furthermore a series of uncommon adverse events are recognized including hepatitis, pancreatitis, vasculitis. Cases of acute interstitial tubular nephritis associated with the use of clozapine have been described in the literature, although this complication is rare. Medical personnel using this drug need to be aware of this potential and serious side effect. We describe the case of a 48-year-old man who developed acute renal failure after initiation of clozapine.

Topics: Acute Kidney Injury; Clozapine; Drug-Related Side Effects and Adverse Reactions; Humans; Male; Middle Aged; Nephritis, Interstitial; Uveitis

Topics: Acute Kidney Injury; Antimanic Agents; Antipsychotic Agents; Clozapine; Drug Therapy, Combination; Humans; Male; Middle Aged; Pancreatitis; Psychotic Disorders; Valproic Acid

Clozapine is the gold-standard antipsychotic medication for treatment-refractory schizophrenia (TRS). However, one potentially lethal side effect of clozapine, as with other antipsychotics, is neuroleptic malignant syndrome (NMS) which could present differently in clozapine therapy. 'Atypical NMS' is a recognised variant of NMS with less rigidity and delayed elevation of creatine kinase; this variant is associated with clozapine.. A case from the author's clinical practice was reviewed.. A 67-year-old man with TRS was treated with clozapine. Unfortunately, his physical condition deteriorated and he presented with atypical NMS, which initially was treated as presumable urinary tract infection.. Atypical NMS is associated with clozapine. This case exposes the potential difficulties in diagnosis, and highlights the importance of considering less common diagnoses in acutely unwell psychiatric patients.

Topics: Acute Kidney Injury; Aged; Antipsychotic Agents; Clozapine; Confusion; Fever; Humans; Male; Neuroleptic Malignant Syndrome; Polypharmacy; Risperidone; Schizophrenia

A 49-year-old man developed acute renal failure due to interstitial nephritis during treatment with the drug clozapine. Referral and diagnosis were delayed through a failure to consider complications of treatment other than neuroleptic malignant syndrome. Although this association has not previously been reported in the literature, we include details of a further 7 cases of acute renal failure in association with clozapine therapy reported to the Committee On Safety Of Medicines in the UK.

Topics: Acute Kidney Injury; Aged; Antipsychotic Agents; Clozapine; Humans; Male; Nephritis, Interstitial