An event is serious (FDA MedWatch definition) when the patient outcome is:

  • death

  • life-threatening

  • hospitalisation

  • disability

  • congenital anomaly

  • requires intervention to prevent permanent impairment or damage

A 62-year-old man with type 2 diabetes mellitus developed nephrogenic diabetes insipidus and chronic kidney disease (CKD) during treatment with lithium for bipolar disorder, and later nephrotic syndrome, active interstitial nephritis, cysts and glomerulosclerosis.

The man, who had been receiving lithium [dosage not stated] for over 10 years, was diagnosed with nephrogenic diabetes insipidus and mild CKD. He had a urine osmolality of 272 mOsm/kg and a serum creatinine level of 1.5 mg/dL, and his concomitant medication included lisinopril.

Lithium was discontinued. Two years later, the man presented for evaluation of stage IV CKD and nephrotic syndrome. On examination, there was trace oedema in his extremities, and urinalysis showed a specific gravity of 1.012, a pH of 5.5 and 3+ protein. Laboratory investigations revealed the following levels: blood urea nitrogen 40 mg/dL, creatinine 3.0 mg/dL, potassium 5.6 mEq/L and albumin 3.5 g/dL. Bilateral nephromegaly and innumerable cysts throughout the kidney were observed on ultrasound. Nephrotic syndrome was diagnosed. A kidney biopsy showed globally sclerosed glomeruli (44%) and extensive atrophy of the tubules (45%). Many micro cysts were noted in the cortex and along the corticomedullary junction. The interstitium showed fibrosis (45%) and inflammation. A diagnosis of lithium-related chronic active interstitial nephritis, micro cysts and glomerulosclerosis was made.

Management included an increased lisinopril dosage. At last follow-up, the man had a serum creatinine level of 3.52 mg/dL and an estimated glomerular filtration rate of 18 mL/min/1.73m2; his urine protein/creatinine ratio was 5.4g of protein per gram of creatinine.Author CommentThe patient “developed nephrogenic diabetes insipidus (NDI) following lithium therapy, which was subsequently complicated by the development of chronic progressive kidney disease; this necessitated the discontinuation of lithium. The patient also presents with the nephrotic syndrome, most likely secondary to [focal global and segmental glomerulonephritis], as a consequence of lithium exposure.”

FormalPara Key words

Interstitial-nephritis - Diabetes-insipidus - Lithium - Kidney-disorders - Nephrotic-syndrome - adverse reactions - drug-induced - Cysts - Focal-segmental-glomerulosclerosis