驾驭治疗绳索：晚期慢性肾病患者难治性锂诱导的肾源性尿崩症

摘要(中文译文)

锂是双相情感障碍管理中最常用且最有效的心境稳定剂。锂诱发的肾性尿崩症（NDI）是长期心境稳定剂治疗公认的并发症。然而，当噻嗪类或阿米洛利等治疗选择因晚期慢性肾脏病（CKD）或电解质不稳定而禁忌时，管理变得极其复杂。我们报告一例60多岁男性，有40年锂使用史，表现为慢加急性肾损伤（AKI）和严重高钠血症（164 mmol/L），对标准去氨加压素治疗无效。本病例凸显了在估算肾小球滤过率（eGFR）低下情况下传统NDI治疗的局限性，以及强化多学科诊疗的必要性。

Abstract

Lithium is the most common and effective mood stabiliser in the management of bipolar disorder. Lithium-induced nephrogenic diabetes insipidus (NDI) is a well-recognised complication of long-term mood stabiliser therapy. However, management becomes exponentially more complex when therapeutic options, such as thiazides or amiloride, are contraindicated due to advanced chronic kidney disease (CKD) or electrolyte instability. We are reporting the case of a man in his 60s with a 40-year history of lithium use who presented with acute-on-chronic kidney injury (AKI) and severe hypernatraemia (164 mmol/L) refractory to standard desmopressin therapy. This case highlights the limitations of conventional NDI treatments in the setting of a low estimated glomerular filtration rate (eGFR) and the necessity of intensive, multidisciplinary care.

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