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

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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].  

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Ultrasonography in chronic lithium nephropathy: a case report

Abstract

Lithium has always been used as a first-choice therapy in bipolar disorders. However, its therapeutic index is restricted by placing patients at risk of potential nephrotoxic effects ranging from polyuria, to Insipid Nephrogenic Diabetes, to chronic kidney disease with a slow reduction of renal function over time. The Nephrologist has the role to diagnose chronic lithium nephropathy, monitoring its evolution and optimizing the management of risks associated with the treatment. In fact, the main objective, to be shared with the psychiatrist, is to encourage the maintenance of therapy even in the presence of nephropathy. Renal ultrasound, a safe, repeatable and low-cost technique, is essential to pursue this goal as it not only confirms the diagnosis of chronic lithium nephropathy hypothesized on the basis of the history and clinical picture, but is also helpful in monitoring its evolution. In this paper, we report a case of chronic lithium nephropathy in order to analyze the etiopathogenesis of renal damage, the clinical-laboratory and histological picture and, in particular, the fundamental role of ultrasound imaging.

 

KEYWORDS: lithium, Insipid Nephrogenic Diabetes, polyuria, nephropathy, renal ultrasound

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

Il litio, elemento-traccia essenziale per la vita umana, è utilizzato in farmacologia clinica da oltre 50 anni quale valido trattamento nei disturbi bipolari per la comprovata efficacia e il basso costo [1], nonostante i potenziali effetti nefrotossici nei pazienti in terapia cronica che vanno dalla poliuria, al Diabete Insipido Nefrogenico (DIN), sino alla malattia renale cronica (MRC) con riduzione progressiva del GFR [2, 3]. 

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