Question:

What serum creatinine level at the time of biopsy has been found to be the only significant predictor of progression to end-stage renal disease in patients undergoing Lithium therapy?
1. Serum creatinine less than 0.6 mg/dL.
2. Serum creatinine 0.6 - 1.2 mg/dL.
3. Serum creatinine greater than 2.5 mg/dL.
4. Serum creatinine 1.5 - 2.5 mg/dL.
5. Serum creatinine less than 1.2 mg/dL.





Answer:

The correct answer for the question "What serum creatinine level at the time of biopsy has been found to be the only significant predictor of progression to end-stage renal disease in patients undergoing Lithium therapy?" is:

3. Serum creatinine greater than 2.5 mg/dL.



Explanation
1.  Serum creatinine less than 0.6 mg/dL.  [Lithium has a narrow therapeutic window, ranging from 0.6 - 1.2 mMol/L.]

2.  Serum creatinine 0.6 - 1.2 mg/dL.  [Lithium has a narrow therapeutic window, ranging from 0.6 - 1.2 mMol/L.]

3.  Serum creatinine greater than 2.5 mg/dL.  [A serum creatinine level of 2.5 mg/dL at the time of biopsy was found to be the only significant predictor of progression to end stage renal disease (ESRD)]

4.  Serum creatinine 1.5 - 2.5 mg/dL.  [Mild toxicity can be seen at serum lithium levels of 1.5-2.5 mMol/L, with moderate toxicity at levels of 2.5-3.5 mMol/L.]

5.  Serum creatinine less than 1.2 mg/dL.  [Lithium has a narrow therapeutic window, ranging from 0.6 - 1.2 mMol/L.]



From the manuscript:
MRI Findings in Chronic Lithium Nephropathy: A Case Report
Radiology Case. 2010 Aug; 4(8):15-21


This article belongs to the GU section.




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From the manuscript

MRI Findings in Chronic Lithium Nephropathy: A Case Report

Free full text article: MRI Findings in Chronic Lithium Nephropathy: A Case Report

Abstract
Patients on long term lithium therapy for affective disorders may develop renal toxicity. It may manifest as nephrogenic diabetes insipidus with renal biopsy showing interstitial fibrosis, sclerotic glomeruli and cyst formation. Magnetic resonance imaging demonstrates the presence of microcysts in patients on long-term lithium therapy, suggesting a possible cause for their nephrotoxicity. We describe the typical magnetic resonance imaging appearance of renal microcysts in a 53 year old woman on chronic lithium therapy.






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