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Lithium-induced nephrogenic diabetes insipidus — ESENeph MCQ

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ModerateInherited and Rare Renal DiseaseLithium-induced nephrogenic diabetes insipidusESENeph

A 48-year-old man on long-term lithium for bipolar disorder has thirst and nocturia. Serum sodium is 148 mmol/L and urine osmolality remains low after water deprivation. Desmopressin produces little rise in urine osmolality. Creatinine is 136 micromol/L. What is the most likely diagnosis?

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Correct answer: D — Nephrogenic diabetes insipidus

Failure to concentrate urine after water deprivation and poor response to desmopressin indicate nephrogenic diabetes insipidus, and lithium is a classic cause. Central diabetes insipidus would respond to desmopressin. SIADH causes hyponatraemia with concentrated urine rather than hypernatraemia and dilute urine. The pearl is that lithium can also cause chronic tubulointerstitial nephropathy, so renal monitoring is important.

Reference: https://guidelines.ukkidney.org