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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: [email protected])
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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

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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