Lithium nephropathy

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis probable

Presentation

Patient with bipolar affective disorder. On chronic lithium therapy.

Patient Data

Age: 65 years
Gender: Female
ultrasound

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. 

Case Discussion

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.   

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