title: Solid renal tumours of collecting duct origin in patients on chronic lithium therapy.
abstract: BACKGROUND
  Lithium (Li) is an invaluable drug for the treatment of bipolar disorder. Long-term Li use is associated with renal complications including the formation of uncomplicated renal cysts caused by proliferation and expansion of collecting duct (CD) cells. We report six patients with complicated renal cysts in the context of Li nephropathy.
  
  
  METHODS
  Over a time period of 15 years, we have identified six patients with one or more solid renal tumours in our population of approximately 50 patients with chronic Li nephropathy. In this study we describe the clinical and pathological characteristics of these Li-related tumours.
  
  
  RESULTS
  All patients were on Li therapy for over 10 years and suffered from varying degrees of Li nephropathy. The tumours were all of CD origin and comprised both oncocytomas and collecting duct carcinomas. The CD carcinomas differed from the very rare "classical" CD cell carcinomas in histological appearance, multifocal presentation and non-aggressive clinical behaviour.
  
  
  CONCLUSIONS
  The increased incidence of CD derived tumours and atypical presentation of CD cell carcinomas in patients with chronic Li nephropathy suggests that Li predisposes to the development of these tumours. We hypothesize that prolonged stimulation of CD cell proliferation and expansion by Li not only causes cyst formation, but can eventually induce the formation of adenomas and carcinomas. Increased awareness of a possible relationship between chronic Li therapy and renal neoplasms, will enhance the knowledge on epidemiology, clinical behavior and optimal therapy for the Li-related renal neoplasms.
authors.affiliation: Department of Nephrology and Hypertension , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Maarten B
authors.initials: MB
authors.lastname: Rookmaaker
authors.affiliation: Department of Pathology , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Heleen A J M
authors.initials: HA
authors.lastname: van Gerven
authors.affiliation: Department of Old-Age Psychiatry , GGZ Ingeest , Haarlem , The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Goldschmeding
authors.affiliation: Department of Nephrology and Hypertension , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Walther H
authors.initials: WH
authors.lastname: Boer
keywords: cancer; cyst; lithium