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B mode ultrasound images of the kidneys demonstrate punctate echogenic foci located in both the renal medulla and cortex. The punctate echogenic appearance is attributed to microcysts (1-2 mm) with fibrotic margin and possible internal calcification.
The patient has been on lithium therapy for her bipolar affective disorder for over 2 decades. There has been a progressive decline in renal function with current eGFR of 40 which prompted referral to renal physician and the ultrasound study.