Lithium toxicity and the kidney with special focus on nephrotic syndrome associated with the acute kidney injury: A case‐based systematic analysis. Issue 12 (2nd April 2021)

• Record Type: Journal Article
• Authors: Łukawska, Emilia; Frankiewicz, Dorota; Izak, Monika; Woźniak, Aldona; Dworacki, Grzegorz; Niemir, Zofia I.
• Is Part Of: Journal of applied toxicology. Volume 41:Issue 12(2021)
• Page Start: 1896
• Page End: 1909
• Publication Date: 2021-04-02
• Subjects: acute kidney injury -- chronic kidney disease -- focal segmental glomerulosclerosis -- lithium toxicity -- membranous nephropathy -- minimal change disease -- nephrotic syndrome; Toxicology -- Periodicals; Industrial toxicology -- Periodicals; Environmentally induced diseases -- Periodicals; Toxicology -- Periodicals; 615.9005
• DOI: 10.1002/jat.4167
• Languages: English
• ISSNs: 0260-437X

Abstract

Abstract: Despite the progress made in treating bipolar and unipolar affective disorders, lithium carbonate is still a common drug in psychiatric practice. Lithium‐related renal side effects include nephrogenic diabetes insipidus, chronic tubulointerstitial nephropathy, and acute kidney injury (AKI). Nephrotic syndrome (NS) is an uncommon but severe complication of lithium treatment. We present a 49‐year‐old female treated with lithium carbonate due to a recurrent depressive disorder who developed NS during this therapy. NS spontaneously remitted after the drug withdrawal. Since her lithium serum levels were within the recommended values, we performed a retrospective analysis of lithium‐induced NS cases trying to determine causes predisposing to the NS development, underlying histopathology, and preservation or irreversible loss of kidney function. This analysis revealed that in lithium‐induced NS with AKI, lithium serum level was the key determinant of AKI development (the β coefficient = 0.8499 with a confidence interval ranging from 0.7452 to 0.9546 and p value < 0.0001). In these cases, the underlying pathology was mainly minimal change disease (MCD), which was quickly reversible upon the drug withdrawal. The development of chronic kidney disease (CKD) seemed to be associated with lithium therapy duration. However, the multiple regression analysis for CKD as the dependent variable showed that the decisive factor was focal segmental glomerulosclerosis (FSGS) as the underlying pathology (the β coefficient = 0.7866 with a confidence interval ranging from 0.600 to 0.9704 and the p value < 0.0001). Thus, we conclude that in lithium‐induced NS/AKI, serum lithium levels contribute to these complications, while FSGS lesions are responsible for CKD's disease progression. Abstract : We present a new lithium‐induced nephrotic syndrome (NS) case with a retrospective analysis of lithium‐induced NS cases trying to determine causes triggering NS development, underlying histopathology, preservation, or irreversible loss of kidney function. We show that in lithium‐induced NS with acute kidney injury, serum lithium levels contribute to these complications, while focal segmental glomerulosclerosis lesions are responsible for chronic kidney disease progression.