Hostname: page-component-7479d7b7d-pfhbr Total loading time: 0 Render date: 2024-07-11T05:50:25.890Z Has data issue: false hasContentIssue false
  • English
  • Français

Clozapine-induced interstitial nephritis in a patient with schizoaffective disorder in the forensic setting: a case report and review of the literature

Published online by Cambridge University Press:  21 June 2019

C. McLoughlin ,
C. Cooney  and
R. Mullaney
C. McLoughlin*
Affiliation:
Tallaght University Hospital, Belgard Square North, Dublin 24, Ireland
C. Cooney
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
R. Mullaney
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
*
*Address for correspondence: Dr Caoimhe McLoughlin, Tallaght University Hospital, Belgard Dublin 24, Ireland (Email: cmcloug6@tcd.ie)
Get access Rights & Permissions [Opens in a new window]

Abstract

We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine. Two years later, clozapine was re-trialled due the refractory nature of her psychiatric symptoms. She subsequently developed renal failure and AIN was confirmed by renal biopsy. Renal function improved after cessation of clozapine; however, she never fully regained normal renal function.

Keywords

Clozapine/adverse effectsinterstitial nephritisrenal failure
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 1 , March 2022 , pp. 106 - 111
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

An, N, Lee, J, Noh, J (2013). A case of clozapine induced acute renal failure. Psychiatry Investigation, 10(1), 92.10.4306/pi.2013.10.1.92CrossRefGoogle ScholarPubMed
AU, A, Luthra, V, Stern, R (2004). Clozapine-induced acute interstitial nephritis. American Journal of Psychiatry, 161(8), 1501–1501.10.1176/appi.ajp.161.8.1501CrossRefGoogle ScholarPubMed
Baker, CD, Pusey, D (2004). The changing profile of acute interstitial nephritis. Nephrology Dialysis Transplantation, 19(1), 8–11.10.1093/ndt/gfg464CrossRefGoogle Scholar
Bugge, E, Nissen, T, Wynn, R (2016). Probable clozapine-induced parenchymal lung disease and perimyocarditis: a case report. BMC Psychiatry, 16(1), 438.10.1186/s12888-016-1158-1CrossRefGoogle ScholarPubMed
Chan, S, Cheung, C, Chan, P, Chau, K (2015). Clozapine-induced acute interstitial nephritis. Hong Kong Medical Journal, 21(4), 372–374.10.12809/hkmj144312CrossRefGoogle ScholarPubMed
Clark, S, Warren, N, Kim, G, Jankowiak, D, Schubert, K, Kisely, S, Forrester, T, Baune, B, Siskind, D (2018). Elevated clozapine levels associated with infection: a systematic review. Schizophrenia Research, 192, 50–56.10.1016/j.schres.2017.03.045CrossRefGoogle ScholarPubMed
Elias, T, Bannister, K, Clarkson, A, Faull, D, Faull, R (1999). Clozapine-induced acute interstitial nephritis. The Lancet, 354(9185), 1180–1181.10.1016/S0140-6736(99)01508-1CrossRefGoogle ScholarPubMed
Espnes, K, Heimdal, K, Spigset, O (2012). A puzzling case of increased serum clozapine levels in a patient with inflammation and infection. Therapeutic Drug Monitoring, 34(5), 489–492.10.1097/FTD.0b013e3182666c62CrossRefGoogle Scholar
Fraser, D, Jibani, M (2000). An unexpected and serious complication of treatment with the atypical antipsychotic drug clozapine. Clinical Nephrology, 54(1), 78–80.Google ScholarPubMed
Grover, S, Mahajan, S, Sharma, N, Aneja, J, Chakrabarti, S (2015). Eosinophilia induced by clozapine: a report of two cases and review of the literature. Journal of Family Medicine and Primary Care, 4(1), 127.10.4103/2249-4863.152269CrossRefGoogle Scholar
Haack, M, Bak, M, Beurskens, R, Maes, M, Stolk, L, Delespaul, P (2003). Toxic rise of clozapine plasma concentrations in relation to inflammation. European Neuropsychopharmacology, 13(5), 381–385.10.1016/S0924-977X(03)00042-7CrossRefGoogle ScholarPubMed
Hunter, R, Gaughan, T, Queirazza, F., McMillan, D., Shankie, S (2009). Clozapine-induced interstitial nephritis – a rare but important complication: a case report. Journal of Medical Case Reports, 3(1), 8574.10.1186/1752-1947-0003-0000008574CrossRefGoogle ScholarPubMed
Jacomb, I, Stanton, C, Vasudevan, R, Powell, H, O’Donnell, M, Lenroot, R, Bruggemann, J, Balzan, R, Galletly, C, Liu, D, Weickert, C, Weickert, T (2018). C-reactive protein: higher during acute psychotic episodes and related to cortical thickness in schizophrenia and healthy controls. Frontiers in Immunology, 9, 2230.10.3389/fimmu.2018.02230CrossRefGoogle ScholarPubMed
Kanofsky, J, Woesner, M, Harris, A, Kelleher, J, Gittens, K, Jerschow, E (2011). A case of acute renal failure in a patient recently treated with clozapine and a review of previously reported cases. The Primary Care Companion For CNS Disorders, 13(3), pii: PCC.10br01091.Google Scholar
Lally, J, al Kalbani, H, Krivoy, A, Murphy, K, Gaughran, F, MacCabe, J (2018). Hepatitis, interstitial nephritis, and pancreatitis in association with clozapine treatment. Journal of Clinical Psychopharmacology, 38(5), 520–527.CrossRefGoogle ScholarPubMed
Lee, L, White, R, Barr, A, Honer, W, Procyshyn, R (2016). Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms. Journal of Psychiatry & Neuroscience, 41(4), E67–E68.10.1503/jpn.150156CrossRefGoogle ScholarPubMed
Leung, J, Nelson, S, Takala, C, Gören, J (2014). Infection and inflammation leading to clozapine toxicity and intensive care. Annals of Pharmacotherapy, 48(6), 801–805.10.1177/1060028014526701CrossRefGoogle ScholarPubMed
Martin, N, Williams, R (2013). Management of clozapine-induced fever: a case of continued therapy throughout fever. Journal of Psychiatry & Neuroscience, 38(4), E9–E10.10.1503/jpn.120206CrossRefGoogle ScholarPubMed
Mohan, T, Chua, J, Kartika, J, Bastiampillai, T, Dhillon, R (2012). Clozapine-induced nephritis and monitoring implications. Australian & New Zealand Journal of Psychiatry, 47(6), 586–587.10.1177/0004867412470170CrossRefGoogle ScholarPubMed
Parekh, R, Fattah, Z, Sahota, D, Colaco, B (2014). Clozapine induced tubulointerstitial nephritis in a patient with paranoid schizophrenia. Case Reports, 2014(may20 1), bcr2013203502–bcr2013203502.Google Scholar
Perazella, M, Markowitz, G (2010). Drug-induced acute interstitial nephritis. Nature Reviews Nephrology, 6(8), 461–470.CrossRefGoogle ScholarPubMed
Raghavan, R, Eknoyan, G (2014). Acute interstitial nephritis: a reappraisal and update. Clinical Nephrology, 82(9), 149–162.10.5414/CN10838CrossRefGoogle ScholarPubMed
Ronaldson, K, Fitzgerald, P, Taylor, A, Topliss, D, McNeil, J (2011). A new monitoring protocol for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Australian & New Zealand Journal of Psychiatry, 45(6), 458–465.10.3109/00048674.2011.572852CrossRefGoogle Scholar
Rossert, J (2001). Drug-induced acute interstitial nephritis. Kidney International, 60(2), 804–817.10.1046/j.1523-1755.2001.060002804.xCrossRefGoogle ScholarPubMed
Siddiqui, B, Asim, S, Shamim, A, Pillai, N, Rajan, S (2007). Simultaneous allergic interstitial nephritis and cardiomyopathy in a patient on clozapine. Clinical Kidney Journal, 1(1), 55–56.CrossRefGoogle Scholar
Southall, K, Fernando, S (2000). A case of interstitial nephritis on clozapine. Australian & New Zealand Journal of Psychiatry, 34(4), 697–698.10.1080/j.1440-1614.2000.0766e.xCrossRefGoogle ScholarPubMed
Walker, A, Lanza, L, Arellano, F, Rothman, K (1997). Mortality in current and former users of clozapine. Epidemiology, 8(6):671–677.10.1097/00001648-199711000-00014CrossRefGoogle ScholarPubMed