Clozapine-Induced Acute Interstitial Nephritis: A Systematic Review.
James Ragg, Stanley Innes, Fearghal Bannon et al.
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In 30 seconds
This systematic review summarised published cases of acute interstitial nephritis (AIN) associated with clozapine, using a search of four databases and independent study assessment. Thirteen cases were included. AIN began after a mean of 34.8 days of clozapine treatment, and fever was the most commonly reported symptom (8/13 cases). Clozapine was stopped in every case; renal function improved in 92%, although one patient developed permanent chronic kidney disease. Three patients required short-term dialysis, and no deaths were reported.
Key findings
- AIN onset followed a mean of 34.8 days of clozapine treatment; reported daily doses ranged from 100 mg to 700 mg.
- Fever was the most common reported symptom, occurring in 8/13 cases.
- After clozapine cessation, renal function improved in 92% of cases; one patient developed permanent chronic kidney disease.
- Three cases required short-term dialysis; none required long-term renal replacement therapy, and no deaths were reported.
Why it matters
The review highlights a potentially serious renal adverse reaction with varied clinical presentations and onset within weeks of starting clozapine in the reported cases. Although outcomes were generally favourable after clozapine was stopped, persistent kidney damage occurred in one case. Awareness of this signal may support timely assessment of renal symptoms and function during treatment.
What to keep in mind
The evidence comprises only 13 published cases, so it cannot establish incidence or reliably compare management approaches.