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Lithium and the kidney: an updated review
1University of California, Los Angeles, Department of Psychiatry, USA. MGitlin@NPIH.medsch.ucla.edu
Drug Safety
|April 30, 1999
Summary
Lithium is a standard mood stabilizer, but long-term use can affect kidney function, particularly tubular ability to concentrate urine. For most patients, these renal effects are benign with proper monitoring and management.
Area of Science:
- Nephrology
- Psychopharmacology
- Internal Medicine
Background:
- Lithium remains a primary mood stabilizer for bipolar disorder, necessitating evaluation of its long-term organ toxicity.
- Renal effects are a significant concern, particularly concerning tubular dysfunction and urine concentrating ability.
Purpose of the Study:
- To review the renal effects of lithium therapy.
- To discuss strategies for minimizing lithium-induced renal toxicity.
Main Methods:
- Review of existing literature on lithium's renal effects.
- Analysis of renal tubular and glomerular function in patients on lithium therapy.
- Examination of clinical strategies for managing renal health during lithium treatment.
Main Results:
- Lithium impairs renal tubular function, causing polyuria due to reduced urine concentrating ability, which may be progressive and irreversible over time.
- Glomerular function is generally not progressively affected by lithium.
- A small subset of patients may develop interstitial nephritis and renal insufficiency.
Conclusions:
- For the majority of patients, lithium's renal effects are benign.
- Minimizing renal toxicity involves avoiding toxicity episodes, monitoring serum lithium levels, regular creatinine monitoring, and potentially once-daily dosing.