Simultaneous allergic interstitial nephritis and cardiomyopathy in a patient on clozapine

Siddiqui, Bina S.; Syed, Asim; Shamim, Afroz; Pillai, Nisha; Rajan, Sujatha

doi:10.1093/ndtplus/sfm003

Cited by 7 publications

(14 citation statements)

References 4 publications

(3 reference statements)

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“…In the cases that reported the following, fever was present in 11/11 cases2,3,5,6,9-15 (100%), eosinophilia in 6 cases3,5,11,12,14,15 (of 8; 75%), elevated C-reactive protein in 5/5 cases2,4,10,13,15 (100%), and proteinuria in 10/10 cases2,3,5,8,10-15 (100%). Six of the cases2,4,5,7,9,10 had renal biopsies performed that showed acute interstitial nephritis, and the others2-4,6,10,11,14,15 were diagnosed by other subjective and objective markers. Clozapine was discontinued in all cases, and patients were treated with supportive therapy, steroids, antibiotics, and/or hemodialysis.…”

Section: Literature Reviewmentioning

confidence: 96%

“…Clozapine was discontinued in all cases, and patients were treated with supportive therapy, steroids, antibiotics, and/or hemodialysis. Kidney function returned to baseline in 6 cases2,4,5,7,9,10 (of 11; 54.55%) and improved but not back to baseline in 5 cases3,6,12-14 (of 11; 45.45%). One case15 reported normal SCr throughout, and 2 cases8,11 did not report kidney function outcome.…”

Section: Literature Reviewmentioning

confidence: 96%

“…It should be noted that 8 cases2,3,8,10-14 (of 14; 57.14%) were receiving concomitant sodium valproate when symptoms occurred, and only 4 cases7,10,11,14 (28.57%) were also receiving lithium. It is unclear what connection, if any, concomitant sodium valproate has to clozapine-associated renal insufficiency, but this link should be explored in the future.…”

Section: Literature Reviewmentioning

confidence: 99%

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Clozapine-associated renal failure: A case report and literature review

Davis¹,

Kelly²

2019

Mental Health Clinician

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One of clozapine's unrecognized potential side effects is renal insufficiency and nephritis. Although most clinicians are aware of the possibility of clozapine-induced myocarditis, less is known about other inflammatory disorders due to clozapine treatment. This patient was started on lithium and clozapine within 4 days of each other although lithium was discontinued after 7 days due to tremor. Routine labs showed an increase in serum creatinine, which was initially attributed to the recent lithium. However, the patient's kidney function continued to worsen, requiring discontinuation of clozapine despite a robust response to a low dose. Several years later, the patient's kidney function improved but has not returned to baseline. This literature review and case report illustrates the similarities in diagnostic presentation of clozapine-associated renal insufficiency as well as potential risk factors. More research should be conducted into the role concomitant sodium valproate and/or lithium play in the risk of clozapine-associated renal insufficiency.

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Section: Literature Reviewmentioning

confidence: 96%

Section: Literature Reviewmentioning

confidence: 96%

Section: Literature Reviewmentioning

confidence: 99%

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Clozapine-associated renal failure: A case report and literature review

Davis¹,

Kelly²

2019

Mental Health Clinician

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“…In 12 (44.4%) cases, clozapine was the only medication reported by the authors (Chatterjee and Safferman, 1997;Druss and Mazure, 1993;Fineschi et al, 2004;Fong et al, 2005;Luo et al, 2007;Nguyen et al, 2017;Pathak et al, 2019;Rami et al, 2006;Sanader et al, 2019;Schonfeldt-Lecuona and Connemann, 2002;Simonson and Kluger, 2018;Thatcher et al, 1995), whereas 15 patients received at least one co-medication other than clozapine (Supplemental Tables S3 and S5). Valproate was co-prescribed in six patients (22.2%) (Au et al, 2004;Chan et al, 2015;Dimitri Valente et al, 2018;Hassine et al, 2017;Parekh et al, 2014;Siddiqui et al, 2008) and lithium in six (22.2%) (Cohen et al, 2015;Hassine et al, 2017;Manfredi and Sabbatani, 2007;Moazez et al, 2018;Siddiqui et al, 2008;Suvarna et al, 2020), with two of them receiving both (Hassine et al, 2017;Siddiqui et al, 2008).…”

Section: Demographic and Clinical Baseline Characteristicsmentioning

confidence: 99%

Unravelling cases of clozapine-related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in patients reported otherwise: A systematic review

et al. 2021

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Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction. Aims: Aim was to review reports of clozapine-related reactions fulfilling the registry of severe cutaneous adverse reaction (RegiSCAR) criteria for DRESS syndrome reported as such or otherwise, to provide a descriptive overview of demographic patterns, clinical manifestations, and DRESS course and investigate associations between demographic, DRESS parameters, and clinical outcomes. Methods: This review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines and registered with PROSPERO (registration number CRD42020156385). We searched PubMed/Embase/PsychInfo/Cochrane for reports of clozapine-related reactions meeting RegiSCAR criteria. Associations between RegiSCAR scores and time-to-recovery with demographic/clinical variables were assessed. Demographic/clinical characteristics of patients with versus without reported DRESS were compared using non-parametrical tests. Results: We identified 26 reports of 27 patients meeting RegiSCAR criteria. Males ( n = 19, 70.4%) and patients with schizophrenia ( n = 18, 66.7%) were mainly affected. Twelve patients (44.4%) received clozapine-monotherapy. DRESS symptoms manifested within a month after clozapine initiation ( n = 24, 88.9%). Lungs and liver were the most common organs involved ( n = 12, 44.4%; n = 11, 40.7%), with a mean time to recovery of 33.75 days. Clozapine rechallenge led to DRESS recurrence in four patients. Death rate was 7.4%. No associations were detected between RegiSCAR criteria or days to recovery with any demographic/clinical variables. No differences between patients with versus without reported DRESS were detected. Conclusions: Clozapine-related DRESS may be rare, but also underreported. Clinicians need to be aware of it even in patients under clozapine-monotherapy or without skin rash.

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“…We identified 20 cases of clozapine induced hepatitis, 11-30 11 cases of nephritis, [31][32][33][34][35][36][37][38][39][40][41]…”

Section: Demographic and Clinical Characteristics Of All Included Casmentioning

confidence: 99%

Hepatitis, Interstitial Nephritis, and Pancreatitis in Association With Clozapine Treatment

Lally¹,

Kalbani

Krivoy³

et al. 2018

J Clin Psychopharmacol

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Clozapine-induced hepatitis, nephritis, and pancreatitis are uncommon adverse events, reflected in the paucity of case studies in the literature. Early recognition of the signs and symptoms of clozapine-associated hepatitis, nephritis, and pancreatitis is important, as when identified, clozapine should be urgently discontinued. Clozapine is associated with evidence of benign inflammatory processes; the extent to which hepatitis, and other inflammatory reactions, may be on a continuum with these more benign and self-limiting reactions is unclear, and this can only be resolved by prospectively following cohorts of clozapine-treated patients.

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Simultaneous allergic interstitial nephritis and cardiomyopathy in a patient on clozapine

Cited by 7 publications

References 4 publications

Clozapine-associated renal failure: A case report and literature review

Clozapine-associated renal failure: A case report and literature review

Unravelling cases of clozapine-related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in patients reported otherwise: A systematic review

Hepatitis, Interstitial Nephritis, and Pancreatitis in Association With Clozapine Treatment

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