Lithium-induced renal disease
Citation, DOI, disclosures and article data
At the time the article was created Charlie Chia-Tsong Hsu had no recorded disclosures.
View Charlie Chia-Tsong Hsu's current disclosuresAt the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.
View Daniel J Bell's current disclosures- Lithium nephropathy
- Lithium induced renal disease
- Lithium-induced chronic renal disease
- Lithium nephrotoxicity
Lithium-induced renal disease is characterized by a progressive decline in renal function secondary to lithium therapy. There is a risk of progression to end-stage renal disease (ESRD).
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Epidemiology
Risk factors
The probability of lithium-induced chronic nephropathy leading to chronic renal failure has a hazard ratio of 2.5% (95% CI 1.6-4) and is related to 4:
increasing age
duration of lithium therapy
This risk seems to persist even after lithium therapy is halted 4.
Clinical presentation
Patients present with signs and symptoms of slowly progressive chronic renal failure or diabetes insipidus.
It is biochemically evidenced by increasing serum creatinine and decreased creatinine clearance.
Pathology
The lithium salt causes direct injury to the renal tubules. Renal biopsy demonstrates tubular atrophy, glomerulosclerosis, chronic interstitial nephritis, and distal tubular dilatation with microcyst formation 1.
Radiographic features
Ultrasound
Unique imaging appearance of numerous uniform microcysts and punctate echogenic foci which may be cortical or medullary in origin 2,4. The kidneys are normal in size.
CT
may show microcalcifications within the microcysts in the renal medulla and cortex
MRI
T2: abundance of microcysts as small hyperintense 1-2 mm round lesions distributed randomly in the renal medulla and cortex 3,4
Treatment and prognosis
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.
Differential diagnosis
References
- 1. Markowitz G, Radhakrishnan J, Kambham N, Valeri A, Hines W, D'Agati V. Lithium Nephrotoxicity. J Am Soc Nephrol. 2000;11(8):1439-48. doi:10.1681/asn.v1181439 - Pubmed
- 2. Di Salvo D, Park J, Laing F. Lithium Nephropathy. J Ultrasound Med. 2012;31(4):637-44. doi:10.7863/jum.2012.31.4.637 - Pubmed
- 3. Farres MT, Ronco P, Saadoun D, Remy P, Vincent F, Khalil A, Le Blanche AF. Chronic lithium nephropathy: MR imaging for diagnosis. (2003) Radiology. 229 (2): 570-4. doi:10.1148/radiol.2292020758 - Pubmed
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