Hunter Robert, Gaughan Tracey, Queirazza Filippo, McMillan Dina, Shankie Susan
Gartnavel Royal Hospital, Glasgow G12 0XH, Scotland, UK.
J Med Case Rep. 2009 Aug 27;3:8574. doi: 10.4076/1752-1947-3-8574.
Given the limited range of effective drug treatments for patients with schizophrenia, increasing numbers of patients, often termed 'treatment-resistant' are prescribed clozapine. While the induction of neutropenia or agranulocytosis by clozapine is well appreciated, other rare potentially fatal adverse reactions may also occur including acute interstitial nephritis as reported in this case.
A 57-year-old Caucasian woman with treatment-resistant chronic schizophrenia developed acute renal failure following initiation of treatment with clozapine. The adverse reaction occurred after only four doses of the drug had been administered (titrated from 12.5 to 25 mg per day). After clozapine had been withdrawn, the patient's renal function returned to normal with no other changes to medication. The patient had been exposed to clozapine about 4 years previously when she had developed a similar reaction.
Renal reactions to clozapine are extremely rare but, if not recognized promptly, may prove fatal. Psychiatrists need to be aware of this possible complication when clozapine is initiated.
鉴于精神分裂症患者有效的药物治疗方法有限，越来越多通常被称为“难治性”的患者被开了氯氮平。虽然氯氮平引起中性粒细胞减少或粒细胞缺乏症已广为人知，但其他罕见的潜在致命不良反应也可能发生，包括本病例报告的急性间质性肾炎。
一名57岁患有难治性慢性精神分裂症的白人女性在开始使用氯氮平治疗后出现急性肾衰竭。该不良反应在仅服用四剂药物（每天从12.5毫克滴定至25毫克）后就发生了。停用氯氮平后，患者的肾功能恢复正常，且未对用药进行其他调整。该患者约4年前曾接触过氯氮平，当时出现了类似反应。
氯氮平引起的肾脏反应极为罕见，但如果不能及时识别，可能会致命。精神科医生在开始使用氯氮平时需要意识到这种可能的并发症。
