Abstract: PUB180
An A-Tip-ical Side Effect of Lithium
Session Information
Category: Trainee Case Report
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- James, Casie, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
- Craver, Randall, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
- Ashoor, Isa, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
Introduction
Lithium is a mood stabilizer approved for bipolar disorder treatment in children as young as 12 years. Though effective in the pediatric population, lithium requires close monitoring for toxicity and adverse effects.
Case Description
An 18 year old male with Hashimoto’s thyroiditis, bipolar I disorder, and anxiety presented with 10 days of edema, weight gain, progressive abdominal pain, emesis, diarrhea, and decreased urine output with frothy urine. Medications included levothyroxine, Risperdal, and lithium. Creatinine was 1.2 mg/dl, up from baseline of 0.8 mg/dl. There was nephrotic-range proteinuria, with spot urine protein/creatinine ratio of 9. Serum lithium level was 2.5 mmol/L (therapeutic range 1-1.2 mmol/L). Renal biopsy showed tip variant focal segmental glomerulosclerosis (FSGS), with diffuse fusion of foot processes, but no tubular epithelial changes. Lithium was discontinued, and the patient underwent diuresis with Lasix/albumin infusions. Proteinuria resolved within two months, and he remains in remission. Bipolar disorder is now treated with Lamictal and Risperdal.
Discussion
Lithium has a wide side effect profile, requiring close monitoring. Lithium-induced nephrotic syndrome is a known, idiopathic side effect. Most renal biopsies show minimal change disease; however, FSGS has also been associated with lithium use. To our knowledge, this is the first documented case of tip variant FSGS in a teenager. While lithium may have induced nephrosis, the low effective circulating volume in nephrotic syndrome with subsequent decrease in glomerular filtration rate likely led to poor excretion of lithium, leading toxic levels and protracted recovery from adverse effects. Despite atypical histology, the patient followed a favorable course and remains in remission without immunosuppressive therapy.
Glomerulus with hilum toward left, slightly below center, and sclerotic segment at the apex adherent to the proximal tubule, at mid-upper right. Variable visceral cell hyperplasia. (Hematoxylin and eosin, 400X)