Lithium-Associated Kidney Microcysts

Abstract

Long-term lithium therapy is associated with impairment in concentrating ability and, occasionally, progression to advanced chronic kidney disease from tubulointerstitial nephropathy. Biopsy findings in patients with lithium-induced chronic tubulointerstitial nephropathy include tubular atrophy and interstitial fibrosis interspersed with tubular cysts and dilatations. Recent studies have shown that cysts are seen in 33–62.5% of the patients undergoing lithium therapy. MR imaging is highly capable of defining renal morphological features and has been demonstrated to be superior to US and CT scan for the visualization of small renal cysts. The microcysts are found in both cortex and medulla, particularly in the regions with extensive atrophy and fibrosis, and can be multiple and bilateral. They tend to be sparse and do not normally exceed 12 mm in diameter. The renal microcysts in the image here reported are subtle, but consistent with lithium-induced chronic nephropathy. An MRI of the kidneys provides noninvasive evidence that strengthens the diagnosis of lithium-induced nephropathy.

Lithium Nephropathy

“…Until the MRI publication by Farres et al 5 in 2003, which reported renal microcysts in 16 patients with chronic lithium nephropathy, radiographic findings had not been described for this condition. Aside from 2 additional MRI case reports, 8 , 9 a single online sonogram, and 2 online CT images, 10 , 11 our literature search failed to uncover any additional imaging information related to lithium nephropathy. Our study grew out of an observation in a single patient whose renal sonogram showed multiple tiny echogenic foci that initially were interpreted as tiny calcifications; on reimaging with the same 6‐MHz transducer but without harmonic imaging, this finding was more suggestive of posterior acoustic enhancement associated with microcysts (Figure 1 and and ).…”

Nephrologische Nebenwirkungen einer Langzeittherapie mit Lithium

“…Bei diesen Patienten finden sich oft insgesamt mehr als 60 Zysten, meist bilateral und insbesondere in den Regionen mit den stärksten fibrotischen und atrophischen Veränderungen (q Abb. 2, Fallbeispiel 2) [38]. Thoma Das Absetzen der Lithium-Therapie hat keinen kurzfristigen Effekt auf den Serum-Kalzium-Spiegel, da der Hyperparathyreoidismus in zwei Drittel der Fälle über Nebenschilddrüsenadeno-me und in einem Drittel der Fälle über eine polyglanduläre Hyperplasie hervorgerufen wird [20].…”

Effets rénaux aigus et chroniques du lithium

“…L'imagerie par résonance magnétique (IRM) permettrait d'évaluer l'importance de l'atteinte rénale ou du moins d'affirmer la présence d'une néphropathie chronique au lithium [24,25]. L'aspect histologique est celui d'une fibrose interstitielle avec atrophie tubulaire, associée à une infiltration inflammatoire, associée à la présence de kystes et de dilatations tubulaires [22,26].…”