碳酸锂通常用于治疗双相情感障碍。一系列副作用与锂有关,包括肾性尿崩症,肾小管性酸中毒,慢性肾小管间质性肾病,和微小变化的疾病。尽管前三种副作用众所周知,微小变化疾病相对罕见。
我们在此报告一例锂治疗引起的微小病变疾病并发慢性肾小管间质性肾病。一名66岁的双相情感障碍患者接受锂治疗20年,出现在医院4周,尿量减少。病史还包括高脂血症,高血压,良性前列腺增生.进一步的实验室调查显示血清锂升高(2.17mmol/L),钾(6.0mmol/L),和肌酐水平(2.92mg/dL),肾病范围蛋白尿,和低蛋白血症.停用锂,并对患者进行静脉输液治疗。他做了肾活检,结果与微小改变疾病并发急性肾小管损伤和慢性肾小管间质性肾病一致。患者随后在门诊接受类固醇治疗。他对治疗没有反应,血液透析开始了.
根据先前报道的病例和文献综述,锂相关微小病变肾病的发生很少见.患有锂相关微小病变疾病和急性肾小管损伤的患者通常对停止锂治疗和/或类固醇治疗有反应。在这种情况下,微小病变肾病为激素耐药,本文报道的患者在随访6个月后肾功能未恢复.我们推测,由于长期使用锂,潜在的原因是慢性肾小管间质性肾病的微小变化疾病。除了众所周知的间质性肾炎或尿崩症的并发症外,该病例还提供了锂诱发的微小病变肾病伴慢性肾小管间质性肾病的罕见副作用的例子。在我们看来,这些患者的临床结局可能更差.
Lithium carbonate is commonly used in the treatment of bipolar disorder. A spectrum of side effects is associated with lithium, including nephrogenic diabetes insipidus, renal tubular acidosis, chronic tubulointerstitial nephropathy, and minimal change disease. Although the former three adverse effects are well-known, minimal change disease is relatively rare.
We herein report a
case of lithium therapy-induced minimal change disease with concurrent chronic tubulointerstitial nephropathy. A 66-year old man with bipolar disorder treated by lithium for 20 years, presented to the hospital with anasarca and decreased urine output for 4 weeks. The medical history also included hyperlipidemia, hypertension, and benign prostatic hyperplasia. Further laboratory investigation revealed elevated serum lithium (2.17 mmol/L), potassium (6.0 mmol/L), and creatinine levels (2.92 mg/dL), nephrotic range proteinuria, and hypoalbuminemia. Lithium was discontinued and the patient was treated with intravenous fluids. He underwent a kidney biopsy, which showed findings consistent with minimal change disease with concurrent acute tubular injury and chronic tubulointerstitial nephropathy. The patient was subsequently treated with steroids in an outpatient setting. He did not respond to the treatment, and hemodialysis was started.
Based on the previously reported cases and review of literature, occurrence of lithium-associated minimal change nephropathy is rare. Patients with lithium-associated minimal change disease and acute tubular injury usually respond to discontinuation of lithium therapy and/or steroid treatment. In this
case, minimal change nephropathy was steroid-resistant and kidney function of the patient reported here did not recover after 6-month follow-up. We postulated the underlying cause to be minimal change disease with chronic tubulointerstitial nephropathy due to long-term lithium use. This
case provides an example of a rare side effect of lithium-induced minimal change nephropathy with chronic tubulointerstitial nephropathy in addition to its well-known complication of interstitial nephritis or diabetes insipidus. In our opinion, these patients likely have much worse clinical outcome.