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Clozapine-Induced Acute Interstitial Nephritis: A Systematic Review
James Ragg1,2, Stanley Innes1,2, Fearghal Bannon1,2
1Adult Mental Health and Wellbeing Program, Eastern Health, Box Hill.
Journal of Clinical Psychopharmacology
|May 20, 2026
Summary
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.
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.
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