Figure 109

Lithium acts both distally and proximally to antidiuretic hormone-induced generation of cyclic adenosine monophosphatase. Polyuria and polydipsia can occur in up to 40% of patients on lithium therapy and are considered harmless and reversible. However, nephrogenic diabetes insipidus may persist months after lithium has been discontinued [7]. Lithium also induces an impairment of distal urinary acidification. Chronic renal failure secondary to chronic interstitial fibrosis may appear in up to 21% of patients on maintenance lithium therapy for more than 15 years [8]. However, these observations are still a matter of debate [7].

FIGURE 10-10 (see Color Plate)

Lithium nephropathy. A 22-year-old female patient was on maintenance lithium therapy (lithium carbonate 750 mg/d) for 5 years. She presented with polyuria (6500 mL/d) and moderate renal failure (creatinine clearance, 60 mL/min). Proteinuria was not present, and the urinary sediment was unremarkable. A renal biopsy showed focal interstitial fibrosis with scarce inflammatory cell infiltrate, tubular atrophy, and characteristic dilated tubule (microcyst formation). Half of the glomeruli (not shown) were sclerotic. (Magnification X 125, periodic acid-Schiff reaction.)

Germanium nephropathy

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