title: Lithium-Induced Minimal Change Disease and Acute Kidney Injury.
abstract: BACKGROUND
  Lithium carbonate is a psychiatric medication commonly used in the treatment of bipolar disorder. It has been implicated in inducing nephrogenic diabetes inspidus, chronic tubulointerstitial nephropathy, and acute tubular necrosis. We describe a case of lithium-induced minimal change disease (MCD) and acute kidney injury (AKI).
  
  
  METHODS
  A 32-year-old female with a medical history of bipolar disorder treated with chronic lithium therapy presented with anasarca, fatigue, and tremors. Work-up revealed supra-therapeutic lithium levels, hypoalbuminemia, and significant proteinuria. The patient was treated conservatively with fluids and discontinuation of lithium therapy. Subsequently, she developed significant AKI and persistent proteinuria. She underwent a renal biopsy that demonstrated effacement of podocyte foot processes consistent with lithium-induced MCD. This was treated with corticosteroids, which decreased the proteinuria and resolved all the patient's symptoms.
  
  
  CONCLUSIONS
  Lithium-induced MCD is a rare disease that affects patients of all ages. It is often associated with therapeutic lithium and is typically resolved with discontinuation of lithium. In some cases, concurrent AKI may result due to vascular obstruction from hyperalbuminuria and associated renal interstitial edema. Corticosteroids may be needed to reduce the proteinuria and prevent progression to chronic kidney disease. As such, patients on lithium therapy may benefit from monitoring of glomerular function via urinalysis to prevent the onset of nephrotic syndrome.
authors.affiliation: Department of Medicine, Michigan State University College of Osteopathic Medicine, Lansing, Michigan, United States.
authors.forename: Parul
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Wong
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zaltzman
keywords: Lithium; minimal change disease; nephrotic syndrome; proteinuria; renal insufficiency