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Published on: April 4, 2025
[Lithium and chronic kidney disease: a pathology which remains relevant]
Paula Félix1, Catherine Stoermann-Chopard, Pierre-Yves Martin
1Service de médecine interne générale, Département de médecine interne, HUG, 1211 Genève 14. paula.felix@hcuge.ch
Abstract:
Lithium continues to be the standard for acute and maintenance treatment of bipolar mood disorders despite the availability of alternative agents. Lithium has a narrow therapeutic index and can result in considerable toxicity. Acute renal intoxication is well-known but chronic kidney disease should be in each doctor's mind. The main manifestations are nephrogenic diabetes insipidus (NDI) and tubulointerstitial nephritis. For NDI, the potassium sparing diuretic amiloride or a thiazide diuretic can improve polyuria. Lithium-induced ESRD in chronic tubulointerstitial nephritis is not uncommon and more prevalent (> 1% among long-term lithium patients) than previously thought. The risk of renal failure may persist even after lithium discontinuation. Additional kidney manifestations of lithium exposure include renal tubular acidosis and hypercalcemia.
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