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Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such as Proteus,...
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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Clozapine-Induced Acute Interstitial Nephritis: A Systematic Review.

James Ragg1,2, Stanley Innes1,2, Fearghal Bannon1,2

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Clozapine can cause acute interstitial nephritis (AIN), a rare kidney complication. Early detection and stopping clozapine are crucial for recovery and preventing permanent kidney damage.

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Area of Science:

  • Nephrology
  • Pharmacology
  • Psychiatry

Background:

  • Clozapine, an atypical antipsychotic, is vital for treatment-resistant schizophrenia.
  • Acute interstitial nephritis (AIN) is a rare but serious side effect of clozapine.
  • Understanding clozapine-induced AIN is critical for patient safety.

Purpose of the Study:

  • To systematically review clozapine-induced AIN cases.
  • To analyze clinical presentations, diagnostics, treatments, and outcomes.
  • To enhance awareness and management of this adverse reaction.

Main Methods:

  • Systematic literature search (Medline, Embase, Cochrane, PsycINFO) following PRISMA guidelines.
  • Independent review and data extraction by two reviewers.
  • Analysis of 13 reported cases of clozapine-induced AIN.

Main Results:

  • AIN onset occurred after a mean of 34.8 days of clozapine treatment (100-700 mg/day).
  • Fever was the most common symptom (8/13 cases); 7 cases used sodium valproate concurrently.
  • Clozapine cessation led to symptom resolution and improved renal function in 92% of cases; one patient had chronic kidney disease.

Conclusions:

  • Clozapine-induced AIN is a rare, idiosyncratic reaction with varied symptoms.
  • Prompt recognition and clozapine discontinuation are key to preventing renal damage.
  • Consider routine renal function monitoring during clozapine therapy for early detection.