Vantipalli Praveena, Roy Sasmit, Koduri Narayana M, Konala Venu Madhav, Garcha Amarinder Singh, Kunaparaju Srikanth, Ayala Raul, Yarram Samanvitha Sai, Adapa Sreedhar
Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA.
J Med Cases. 2022 Jul;13(7):322-329. doi: 10.14740/jmc3934. Epub 2022 Jun 16.
Acute interstitial nephritis (AIN) classically presents as acute kidney injury most often induced by offending drugs. Less frequently it is secondary to infections, autoimmune disorders, or idiopathic conditions. Development of drug-related AIN is not dose dependent and a recurrence can occur with re-exposure to the drug. We present a 50-year-old male with treatment resistant schizoaffective disorder who developed clozapine-induced AIN, confirmed with kidney biopsy within 2 months of taking this medication. His kidney function improved with removal of the drug and treatment with steroids. However, his kidney function was again significantly impaired when rechallenged with even a lower dose of clozapine a year later. Kidney function returned to baseline after stopping clozapine. Monitoring of kidney function during clozapine therapy is essential to therapy. Prompt diagnosis is imperative as discontinuation of offending agent can prevent acute kidney injury.
急性间质性肾炎（AIN）通常表现为急性肾损伤，最常见的诱因是致病药物。较少情况下，它继发于感染、自身免疫性疾病或特发性疾病。药物相关性AIN的发生与剂量无关，再次接触该药物时可能会复发。我们报告一名50岁患有难治性精神分裂症的男性，他在服用氯氮平后2个月内发生了氯氮平诱发的AIN，经肾活检确诊。停用该药物并使用类固醇治疗后，他的肾功能得到改善。然而，一年后再次使用更低剂量的氯氮平进行激发试验时，他的肾功能再次严重受损。停用氯氮平后，肾功能恢复到基线水平。在氯氮平治疗期间监测肾功能对治疗至关重要。由于停用致病药物可预防急性肾损伤，因此及时诊断至关重要。
