Lithium-induced nephropathy; One medication with multiple side effects: a case report.

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Lithium carbonate is a primary treatment for bipolar disorder.
• Common lithium side effects include nephrogenic diabetes insipidus and renal tubular acidosis.
• Minimal change disease is a rare but serious adverse effect of lithium therapy.

Observation:

• A 66-year-old male on long-term lithium therapy presented with anasarca and reduced urine output.
• Laboratory results revealed elevated lithium levels, nephrotic range proteinuria, and acute kidney injury.
• Kidney biopsy confirmed minimal change disease with concurrent acute tubular injury and chronic tubulointerstitial nephropathy.

Findings:

• The patient's condition was steroid-resistant, necessitating hemodialysis.
• This case illustrates a rare instance of lithium-induced minimal change nephropathy combined with chronic tubulointerstitial nephropathy.
• Unlike typical cases, this patient experienced a poor renal outcome despite treatment cessation and steroid administration.

Implications:

• This case underscores the potential for severe, treatment-resistant kidney complications from lithium therapy.
• Long-term lithium use may predispose patients to a combination of nephropathies with poorer prognoses.
• Clinicians should consider rare renal adverse effects like minimal change disease in patients on lithium presenting with nephrotic syndrome.