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

2019 ◽  
pp. 1-6
Author(s):  
C. McLoughlin ◽  
C. Cooney ◽  
R. Mullaney
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Schizoaffective Disorder ◽  
Inflammatory Markers ◽  
Respiratory Symptoms ◽  
Rare Case ◽  
Psychiatric Symptoms ◽  
Acute Interstitial Nephritis ◽  
Review Of The Literature ◽  
Forensic Setting

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.

scholarly journals The mechanisms of acute interstitial nephritis in the era of immune checkpoint inhibitors in melanoma

2019 ◽  
Vol 11 ◽  
pp. 175883591987554 ◽  
Author(s):  
Marco Tucci ◽  
Anna Passarelli ◽  
Annalisa Todisco ◽  
Francesco Mannavola ◽  
Luigia Stefania Stucci ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Acute Interstitial Nephritis ◽  
Clinical State ◽  
High Dose ◽  
Systemic Symptoms ◽  
The Impact

Treatment with immune checkpoint inhibitors (ICIs) has improved the prognosis of patients with a number of types of cancer, but the frequent development of immune-related adverse effects (irAEs) can worsen the outcome. The most common irAEs involve the gastrointestinal, cutaneous, and endocrine systems, but nephrotoxicity, resulting from damage to the tubule-interstitial compartment, may occur in some patients. The early phases of acute interstitial nephritis (AIN) are characterized by systemic symptoms that indicate a poor clinical state as well as a mild deterioration of renal function. Tubular injury is due to a direct effect mediated by cytotoxic CD8+ T cells, which sustain the local production of pro-inflammatory cytokines that progressively impair renal function. The treatment of AIN is mainly based on high-dose steroids, which in most instances leads to the recovery of renal function. However, the premature discontinuation of ICI therapy may prevent the impact of treatment on the clinical progression of the malignancy. Adequately addressing irAEs requires a standardized therapy that is based on the results of large clinical trials.

Delayed Renal Function Recovery From Drug-Induced Acute Interstitial Nephritis

2012 ◽  
Vol 343 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Dongmei Chen ◽  
Chunlei Luo ◽  
Zheng Tang ◽  
Yan Zhou ◽  
Huiping Chen ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Drug Induced ◽  
Renal Function Recovery ◽  
Function Recovery

COX-2 inhibitors and acute interstitial nephritis: case report and review of the literature

2005 ◽  
Vol 63 (05) ◽  
pp. 385-389 ◽  
Author(s):  
J.-B. Esteve ◽  
V. Launay-Vacher ◽  
I. Brocheriou ◽  
A. Grimaldi ◽  
H. Izzedine
Keyword(s):  
Case Report ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Review Of The Literature ◽  
Cox 2 ◽  
Cox 2 Inhibitors

scholarly journals Longterm renal outcome of biopsy-proven acute tubular necrosis and acute interstitial nephritis

2019 ◽  
Author(s):  
Hyunseo Kim ◽  
Sang Kyung ◽  
Shin Young Ahn ◽  
Young Joo Kwon ◽  
Hajeong Lee ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Acute Tubular Necrosis ◽  
Female Gender ◽  
Acute Interstitial Nephritis ◽  
Renal Outcome ◽  
Pathological Features ◽  
University Hospitals ◽  
Glomerular Diseases ◽  
Tubular Necrosis

Abstract Background: Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), longterm renal outcome of AKI still remains unclear. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Methods: Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined. Results: Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, p=0.007) with a 2.709-fold higher risk of non- recovery compared to ATN (95% CI: 1.203–6.470). During the mean follow up of 76.5±91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.050; 95% CI: 2.420-219.533) and also in ATN (12.136; 95% CI, 1.186-24.235) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD. Conclusions: Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD.

scholarly journals Acute interstitial nephritis with immunotherapy; a growing entity?

2020 ◽  
Vol 9 (4) ◽  
pp. e35-e35
Author(s):  
John David Chetwood ◽  
Lin Lin Myat ◽  
Helen Lammi ◽  
Mani Panat ◽  
James Hughes
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Interstitial Nephritis ◽  
Cancer Survival ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Response To Treatment ◽  
Immune Mediated ◽  
Life Threatening ◽  
Potential Impact

We report a case of acute kidney injury (AKI) secondary to immune-mediated acute interstitial nephritis (AIN), with supporting diagnostic results and a successful response to treatment. This entity is gaining increasing recognition with the burgeoning use of immunotherapy agents in oncology. The timeline for the development of AIN from the initiation of immunotherapy varies, and may range in severity from asymptomatic to severe, organ-threatening and with life threatening consequences. Renal biopsy should be performed to confirm the diagnosis due to the potential impact of discontinuation of immunotherapy on cancer survival. Re-challenge with immunotherapy is reasonable once renal function recovers.

scholarly journals Clinical Manifestations and Outcome of Fluoroquinolone Associated Acute Interstitial Nephritis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S297-S297
Author(s):  
Saira Farid ◽  
Omar AbuSaleh ◽  
Maryam Mahmood ◽  
Zerelda Esquer Garrigos ◽  
Abdurrahman Hamadah ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Treatment Duration ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Flank Pain ◽  
High Index Of Suspicion ◽  
Baseline Renal Function ◽  
Antibiotic Treatment Duration

Abstract Background Fluoroquinolones (FQ) are among the most commonly prescribed antibiotics. Nephrotoxicity related to FQ use is infrequently reported and the mechanism of renal injury is incompletely elucidated. We describe clinical manifestations and outcome of patients with biopsy proven acute interstitial nephritis (AIN) associated with FQ use at our institution. Methods We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic Rochester from 1993 to 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy proven AIN that were attributed to FQ use. Results We identified 24 patients with FQ-related biopsy-proven AIN. The most commonly used FQ was ciprofloxacin (71%) with median antibiotic treatment duration of 7 days (Figure 1). The median duration between starting FQ and the diagnosis of AIN was 8.5 (IQR: 17). Common clinical manifestations included fever (50%), flank pain (8%), and skin rash (21%). However, 17% of the patients were asymptomatic at the time of diagnosis (Figure 2). Majority (58%) of the patients recovered following discontinuation of antibiotics and returned to baseline renal function at a median of 20.5 (IQR: 15.5). Six patients required temporary hemodialysis and 9 patients received steroids. Conclusion Onset of FQ-related AIN can be delayed and a high index of suspicion is needed by physicians prescribing these agents. Overall outcomes are favorable with recovery to baseline renal function within 3 weeks of discontinuing the offending drug. Disclosures All authors: No reported disclosures.

scholarly journals A rare case of lamotrigine-induced acute interstitial nephritis

2016 ◽  
Vol 6 (6) ◽  
pp. 32976
Author(s):  
Atul Matta ◽  
Nour Abou Assalie ◽  
Rajib K. Gupta ◽  
Maria del Pilar Morales ◽  
Ricardo Conti
Keyword(s):  
Interstitial Nephritis ◽  
Rare Case ◽  
Acute Interstitial Nephritis
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