Lithium is the treatment of choice in bipolar disorders. Long-term use has important side effects such as nephrotoxicity. A 37-year-old female patient on lithium with proteinuria and renal failure was diagnosed as having chronic tubulointerstistial nephritis and secondary focal segmental glomerulosclerosis at renal biopsy. These fi ndings were linked to lithium use. We present this case as it is a rare event.