Minimal change disease during lithium therapy: case report

Abstract

Lithium is a largely used and effective therapy in the treatment of bipolar disorder. Its toxic effects on kidneys are mostly diabetes insipidus, hyperchloremic metabolic acidosis and tubulointerstitial nephritis. Also, a correlation between lithium and minimal change disease has sometimes been described.

We report here the case of a patient with severe bipolar disorder on lithium therapy who, without any pre-existing nephropathy, developed nephrotic syndrome and AKI with histopathologic findings pointing to minimal change disease.

The patient was treated with symptomatic therapy; the discontinuation of lithium therapy resulted in the remission of AKI and of the nephrotic syndrome, thus suggesting a close relationship between lithium and minimal change disease.

 

Keywords: minimal change disease, lithium, nephrotic syndrome

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

Introduzione

La glomerulonefrite a lesioni minime è una delle principali cause di sindrome nefrosica idiopatica. Nella popolazione adulta rappresenta circa il 15% dei casi di sindrome nefrosica idiopatica, rappresentandone la terza causa, in ordine di importanza, dopo la glomerulonefrite membranosa e la sclerosi segmentaria e focale [1, 2, 3].  

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.

Minimal Change Relapse During Pregnancy

Abstract

The appearance of nephrotic syndrome during pregnancy is considered an exceptional event, whose incidence is around 0.012-0.025% of all pregnancies, and it is even more rare when the cause is represented by minimal lesions glomerulonephritis. In this article we will describe the case of a patient with a histological diagnosis of glomerulonephritis with minimal lesions, tending to frequent relapses. She was in complete remission since 2013 after treatment with cyclosporine. suspended in May 2017. After few weeks she become pregnant, and the pregnancy was regular until the 23rd week. when a recurrence of nephrotic syndrome appears. She was treated with steroids bolus followed by oral steroid, and afterwards gave birth to a live fetus with spontaneous delivery at 37 weeksThe few data in the literature confirm that recurrence of glomerulonephritis due to minimal lesions in pregnancy should be treated rapidly with steroids, that can induce rapid remission and protect both the pregnant than the fetus from even serious damage.

Keywords: Minimal change nephropathy, pregnancy, nephrotic syndrome, steroid.

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

INTRODUZIONE

La glomerulonefrite a lesioni minime è definita dalla normalità dei glomeruli all’esame in microscopia ottica, e dalla presenza all’esame ultrastrutturale glomerulare della fusione dei pedicelli dei podociti. La glomerulonefrite a lesioni minime si caratterizza per la presenza di proteinuria e per la sensibilità all’uso di steroidi.

 

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.