Abstract

Long-term lithium therapy is known to cause renal dysfunction, including nephrogenic diabetes insipidus (nDI) and chronic tubulointerstitial nephropathy, which may progress to end-stage renal disease (ESRD) in approximately 1% of patients. We report a case of resolution of lithium-induced nDI following living related kidney transplantation for ESRD secondary to chronic lithium toxicity. A 63-year-old male presented with ESRD and a 22-year history of severe nDI following 11 years of oral lithium treatment for bipolar disorder. He underwent a preemptive 1-haplotype matched living related kidney transplant from his son. Prior to the transplant, he had a daily urine output of 10-14 L. One month following transplant, the patient's daily urine output decreased to 2-3 L. His kidney function stabilized with a serum creatinine of 1.4 mg/dl (6.4 mg/dl pre-operatively). Doppler ultrasound supports a functional shift from native kidneys to renal allograft. This case report demonstrates reversal of nDI with kidney transplantation in a patient with ESRD secondary to lithium nephropathy, and highlights our poor understanding of this functional shift.

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