Abstract
Long-term lithium therapy is known to cause renal dysfunction, including nephrogenic diabetes insipidus (nDI) and chronic tubulointerstitial nephropathy, which may progress to end-stage renal disease (ESRD) in approximately 1% of patients. We report a case of resolution of lithium-induced nDI following living related kidney transplantation for ESRD secondary to chronic lithium toxicity. A 63-year-old male presented with ESRD and a 22-year history of severe nDI following 11 years of oral lithium treatment for bipolar disorder. He underwent a preemptive 1-haplotype matched living related kidney transplant from his son. Prior to the transplant, he had a daily urine output of 10-14 L. One month following transplant, the patient’s daily urine output decreased to 2-3 L. His kidney function stabilized with a serum creatinine of 1.4 mg/dl (6.4 mg/dl pre-operatively). Doppler ultrasound supports a functional shift from native kidneys to renal allograft. This case report demonstrates reversal of nDI with kidney transplantation in a patient with ESRD secondary to lithium nephropathy, and highlights our poor understanding of this functional shift.
Highlights
Following lethal cases of lithium intoxication in the 1950s, lithium was removed from the market as a table salt substitute
Lithium is absorbed through Epithelial Na Channels (ENaC) in the principal cells, where it may accumulate and induce nephrotoxic effects characterized by reduced urinary concentrating capacity [2,3]
The most common adverse effect of chronic lithium therapy is nephrogenic diabetes insipidus, which occurs in 40-50% of patients receiving lithium therapy [4,5]
Summary
Following lethal cases of lithium intoxication in the 1950s, lithium was removed from the market as a table salt substitute. ESRD: End-Stage Renal Disease; nDI: Nephrogenic Diabetes Insipidus; CKD: Chronic Kidney Disease; LRKT: Living Related Kidney Transplant; GFR: Glomerular Filtration Rate; ENaC: Epithelial Na Channel We present a case of severe nDI and ESRD secondary to lithium toxicity successfully treated by kidney transplantation.
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