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Lithium Nephropathy

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CT coronal image showing lithium nephropathy cysts
CT axial  image showing lithium nephropathy cysts
Coronal and Axial CT images from a patient on long term Lithium therapy show innumerable micro cysts randomly distributed in both kidneys.

Lithium Nephropathy / Lithium induced renal disease

Radiology features

  • Multiple innumerable micro cysts randomly distributed in BOTH cortex and medulla or predominantly cortex are characteristic radiology findings in cases of lithium induced renal disease/lithium nephropathy.
  • Cysts are usually 1-2mm in diameter.
  • Cysts arise from distal tubular structures and collecting ducts.
  • Best seen on T2W MRI images.
Lithium Nephropathy MRI coronal view

T2W MRI images in another patient shows tiny subcentimeter sized in both kidneys.

  • Cysts can also bee seen on USG : Lithium nephropathy sonographic findings
  • Differentials diagnosis with imaging features:
    • Autosomal polycystic kidney (ADPKD)
      •  Nephromegaly with large cysts.
      • Cysts are often of varying sizes and few of them are complicated.
    • Glomerulocystic kidney disease:
      • Patients are usually children or young adult.
      • Cysts arise from Bowman space so ONLY in CORTEX of the kidney.
    • Medullary cystic kidney disease:
      • Cysts are present in the medulla and corticomedullary junction but spare the cortex.
    • Acquired cystic kidney disease
      • Seen in patients on long term dialysis.
      • Cysts are NOT uniform in size although they affect both cortex and medulla.

Clinical features and pathology of lithium nephropathy:

  • Lithium is used to treat unipolar major depression and bipolar affective disorders.
  • Lithium toxicity spectrum includes:
    • Acute intoxication.
    • Nephrogenic diabetes insipidus / Polyuria-polydipsia syndrome: Harmless and reversible.
    • Chronic renal disease (10-20 years): Chronic focal interstitial nephritis
  • Approx. 30-60% of patients on long term lithium therapy can have cysts.
  • Patients with chronic interstitial nephritis and typical cysts are at risk of developing end-stage renal disease. 


References and further reading:

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