Asymptomatic renal failure in a patient with bipolar disease without lithium therapy

A 48-year-old Chinese woman with a history of major depressionand bipolar disease, controlled by bromazepam, clozapine, fluoxepineand lamotrigine for several years, presented with microscopichaematuria (red blood cells: 10–25 per high power fieldon urinalysis) and acute renal failure (serum creatinine: 1.6mg/dL with a baseline value 0.8 mg/dL) upon routine health exam.She was referred to our hospital for further work-up. She deniedany previous ingestion of lithium. Neither analgesics nor anti-inflammatoryagents were used by the patient in the recent past. Her bodyweight (BW) was 71 kg. She showed no signs of dehydration, oedema,