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Case Reports
. 2019 Jun 3:2019:5406482.
doi: 10.1155/2019/5406482. eCollection 2019.

Lithium-Induced Chronic Kidney Disease in a Pediatric Patient

Neena Gupta  1 , Meghan Gibson  2 , Ellen C Wallace  3
Affiliations
Case Reports

Lithium-Induced Chronic Kidney Disease in a Pediatric Patient

Neena Gupta et al. Case Rep Pediatr. .

Abstract

Lithium-induced nephropathy usually manifests in adulthood as it develops slowly after many years of cumulative exposure. There is very limited information available in pediatric patients. Renal function monitoring and timely intervention is the key in preventing lithium-induced chronic kidney disease in these patients. We report a case of a 14-year-old boy who was on lithium for almost 9 years for his complex psychiatric illness. He presented with increased urinary frequency and nocturia. His serum creatinine increased to 1.15 mg/dL (estimated glomerular filtration rate or eGFR 53 ml/min/1.73 m2) from a baseline of 0.78 mg/dL (eGFR 86 ml/min/1.73 m2) a year prior to this presentation. Results of the imaging study were consistent with lithium-induced nephropathy. He was managed conservatively. His serum creatinine returned to baseline of 0.78 mg/dL after a year of discontinuation of lithium, consistent with mild chronic kidney disease. This case highlights the fact that lithium-induced chronic kidney disease can present in pediatric age group when lithium is initiated at a young age in children and that timely intervention may prevent further progression of renal damage. In addition to drug levels, routine monitoring of renal function during lithium therapy is essential.

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Figures

Figure 1
Figure 1
Time course of serum creatinine and lithium level.
Figure 2
Figure 2
Renal ultrasound. (a) Sagittal left kidney: echogenic pyramids, punctuate hyperechoic foci in cortex, comet tail artifact (black arrow outlined in white), and small cyst with through transmission (white arrow with black outline). (b) Sagittal left kidney: echogenic pyramids with many punctuate hyperechogenicities. Two tiny sonolucent cysts with through transmission (black arrows with white outlines). (c) Sagittal right kidney: many punctuate cortical hyperechogenicities. (d) Transverse right kidney: generally increased cortical echogenicity (star) relative to adjacent liver (triangle).
Figure 3
Figure 3
Lithiumeter (adapted from Malhi G. S. et al, Journal of Affective Disorders, 2017; 217–266).
See this image and copyright information in PMC

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