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Case of the Month

November 2013

Patient Data: Femal patient 43 years old

Clinical Info: Impaired renal function in a patient treated for psychiatric problems for many years

Longitudinal image of the right kidney

Another longitudinal image of the right kidney

Transverse image of the right kidney

Longitudinal image of the left kidney

Another longitudinal image of the left kidney

Longitudinal image of the same patient 10 years earlier

Another image made 10 years earlier

51502-lithium_kidneys1.swf MRI

51503-lithium_kidneys2.swf MRI

51504-lithium_kidneys3.swf MRI

Longitudinal image of the right kidney of a 55 year old male patient who also uses lithium for a long time. The kidneys show the same abnomalities

Transverse image of the right kidney

Longitudinal image of the left kidney

Both patients were treated with lithium for many years causing so called lithium kidneys
The predominant form of chronic renal disease associated with lithium therapy is a chronic tubulointerstitial nephropathy. The image findings of renal disease that distinguish patients treated with lithium from other renal cystic disorders are the presence of distal tubular dilatation and microcysts. These cysts are present in 33%-62% of patients undergoing lithium therapy. They are localized in both the cortex and the medulla. In general, they do not exceed 1-2 mm in diameter. Lithium-associated kidney microcysts are usually echogenic on ultrasound examination because these cysts are lined by cuboidal epithelial cells in a stroma, which is surrounded by fibrosis. This surrounding fibrosis dominates the ultrasound image and appears as echogenic foci. CT and MRI demonstrate the usual appearance of cysts except the size is usually in 1-2mm range and no contrast enahancement is present.

for more renal polycystic abnormaities see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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