Abstract: PUB340
Lithium-Induced Nephrotic Syndrome: A Rare Complication of a Known Kidney Offender
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Pendyala, Megha Eshani, Williamsville Central School District, East Amherst, New York, United States
- Pendyala, Reshub R., Nichols School, Buffalo, New York, United States
- Pendyala, Prashant, Buffalo General Medical Center, Buffalo, New York, United States
Introduction
Lithium is commonly used effective medication for treatment of bipolar and unipolar disorders. A variety of renal complications have been well described with Lithium usage. Nephrogenic diabetes insipidus, chronic interstitial nephropathy and renal tubular acidosis being the common ones. Nephrotic syndrome is a rare but known complication.
Case Description
A 34 yr old lady presented to the emergency room with complaints of generalized edema and weight gain of 25 lbs in a 3-day period. She has known history of severe depression and suicidal ideation. She has been taking Lurasidone, Clonazepam, Desvenlafaxine and Mydayis. She was started on Lithium Carbonate 4 months prior. No NSAID intake.
She was found to have anasarca. The Lithium level was normal (1.14 mmol/l). She had 17gm of urine protien. The total cholesterol was 405 mg/dl, serum albumin of 1.5gm/dl. Creatinine was mildly elevated at 1.32gm/dl. Serology for Hepatitis and HIV were negative. Rheumatoid Factor, Antinuclear and anti DNA antibodies were also negative.
Lithium was discontinued. Two weeks later the urine protein had decreased to 12.5 gm and serum albumin was 1.7gm/dl. Four weeks later her edema had resolved. Her proteinuria had completely resolved and serum albumin 2.9gm/dl with a normal creatinine. In a six month follow up she did not have any proteinuria; her serum albumin and cholesterol were normal.
She did not get a kidney biopsy and was not started on steroids
Discussion
Lithium induced nephrotic syndrome is a rare occurrence. Only around 30 cases have been reported. Our patient was on Lithium for 4 months prior to the onset of symptoms. Usual duration described was 1 to 12 months. These patients respond well to discontinuation of lithium with most of them recovering within few weeks. The Lithium levels in our patient were therapeutic showing that it is likely an idiosyncratic reaction and not a result of toxicity. Review of literature shows that usually these patients do not need treatment with steroids and there is no need for kidney biopsy. However, if the symptoms persist beyond 6 weeks, a kidney biopsy to exclude other causes and treatment with prednisone have been done in the case reports. Kidney biopsy usually shows minimal change disease.
This case provides an example of a rare renal side effect of Lithium that occurs after relative short duration of treatment.