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Kidney Week

Abstract: SA-PO292

Two Cases of Lurasidone-Associated AKI

Session Information

  • Trainee Case Reports - VI
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 103 AKI: Mechanisms

Authors

  • Shah, Nimesh K., Lenox Hill Hospital, New York, New York, United States
  • Barta, Valerie Suzanne, Hofstra Northwell School of Medicine Lenox Hill Hospital, New York, New York, United States
  • Sheikh, Fatima, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, United States
  • Shah, Hitesh H., Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
Introduction

Lurasidone (Latuda) is a novel atypical antipsychotic used for schizophrenia and bipolar disorder. AKI has rarely been reported with lurasidone in trials. We report the first two clinical cases of AKI with lurasidone, including the first case of biopsy proven chronic interstitial nephritis (CIN).

Case Description

Case 1: 70-year old bipolar female was sent to ER for serum creatinine (Scr) of 8.4mg/dL. Scr was 1mg/dL six months prior. Medications included lurasidone, escitalopram, lamotrigine, lithium (Li), alprazolam, amphetamine, anastrazole, propranolol, and metformin. Lurasidone was the only new medication, started 6 months prior. Vitals and physical exam were unremarkable. Serum potassium was 6mmol/L, CO2 13mmol/L and Li 0.6mmol/L. 24-hr urine protein was 0.7g. Serologic work-up was negative. Metformin and Li stopped and patient discharged with Scr of 6.2mg/dL. Patient re-hospitalized one month later for Scr 9.8mg/dL requiring 3 sessions of hemodialysis for uremia. Kidney biopsy showed ATN and severe chronic interstitial nephritis (CIN). The lack of micro-cysts or granulomatous CIN was inconsistent with Li or lamotrigine induced AKI respectively. Oral corticosteroids initiated and lurasidone was held. Scr decreased to 2.6mg/dL four weeks later.

Case 2: 50-year old male with schizophrenia was seen in clinic for elevated Scr of 1.6mg/dL. Scr was 1.3, 6 months prior to presentation. Medications included lurasidone, clozapine, clozaril, klonopin, lamictal, tamsulosin and metoprolol. Physical exam was unremarkable. Spot urine total protein-to-creatinine was 0.1. Serological work-up was negative. Lurasidone dose was reduced from 160mg to 80mg daily and Scr subsequently decreased to 1.3mg/dL.

Discussion

A review of FDA Adverse Event Reporting System (FAERS) revealed AKI in 18/3076 users of lurasidone. All cases were female ≥60years with AKI seen within 1yr of drug initiation. CrCl <50mL/min raises serum levels of lurasidone thereby increasing risk of AKI, as does adjunctive therapy with Lithium. AKI improved in our cases after discontinuation and steroids, or reduction of lurasidone therapy alone. It is important for clinicians to be aware of the potential AKI and CIN risk associated with lurasidone so renal function can be closely monitored in these patients.