Clozapine induced tubulointerstitial nephritis in a patient with paranoid schizophrenia.

We describe the development of tubulointerstitial nephritis after starting clozapine therapy in a patient with treatment-resistant schizophrenia. A 54-year-old mixed-race patient with a longstanding history of paranoid schizophrenia was started on the antipsychotic clozapine. Two months after starting clozapine he developed fevers, cough and acute renal failure which initially responded to 7 days of prednisolone but recurred after completing the steroid course. Renal biopsy confirmed acute tubulointerstitial nephritis and he was started on a course of steroids with renal recovery in 72 h. Clozapine was later stopped. This case highlights a serious and potential life-threatening complication of an important antipsychotic used in treatment-resistant schizophrenia.