Lithium-induced renal disease
Lithium-induced renal disease is characterised by a progressive decline in renal function, evidenced by increasing serum creatinine and decreased creatinine clearance. The lithium salt causes direct injury to the renal tubules. The duration of lithium therapy increases the risk of progression to end-stage renal disease (ESRD), however, discontinuation of medication may not necessarily halt the progression to ESRD.
Renal biopsy demonstrates tubular atrophy, glomerulosclerosis, chronic interstitial nephritis, and distal tubular dilatation with microcyst formation 1.
Unique imaging appearance of numerous uniform microcysts and punctate echogenic foci which may be cortical or medullary in origin 2. The kidneys are normal in size.
- may show microcalcifications within the microcysts in the renal medulla and cortex
- T2: abundance of microcysts as small hyperintense 1-2 mm round lesions distributed randomly in the renal medulla and cortex 3
- 1. Markovitz GS, Radhakrishnan J, Kammbham N, Valeri AM, Hines WH, D’Agati VD. Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy. J Am Soc Nephrol 2000; 11:1439-1448.
- 2. Di Salvo DN, Park J, Laing FC.Lithium nephropathy: unique sonographic findings. J Ultrasound Med. 2012;31(4):637-44.
- 3. Farres MT, Ronco P, Saadoun D, Remy P, Vincent F, Khalil A, Le Blanche AF.Chronic lithium nephropathy: MR imaging for diagnosis. Radiology. 2003;229(2):570-4.