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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. However, the majority of drugs are either weak acids or weak bases, and their ionization level is dependent on pH. By altering the pH of urine, the...
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Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Renal function after withdrawal of lithium.

Rocco Hoekstra1, Marius N Lekkerkerker2, Tjallingius M Kuijper3

  • 1Outpatient Clinic for Bipolar Disorders, Antes Center for Mental Health Care, Rotterdam, The Netherlands.

Bipolar Disorders
|January 25, 2022
PubMed
Summary

Discontinuing lithium therapy can improve kidney function in most patients. Studies show that stopping lithium often leads to better estimated glomerular filtration rate (eGFR) or a slower decline in renal function.

Keywords:
chronic kidney diseasediscontinuationglomerular filtration ratelithiumrenal insufficiency

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Area of Science:

  • Nephrology
  • Pharmacology

Background:

  • Chronic lithium therapy is associated with the development of chronic kidney disease.
  • Assessing the potential for renal function recovery after lithium discontinuation is crucial for clinical decision-making.

Purpose of the Study:

  • To investigate the trajectory of renal function in patients previously on chronic lithium therapy after lithium withdrawal.
  • To determine if discontinuing lithium therapy leads to improvement in kidney function.

Main Methods:

  • A cohort of patients on chronic lithium therapy was selected from a large database.
  • Patients who discontinued lithium and had available creatinine values at least six months post-withdrawal were analyzed.
  • The slope of estimated glomerular filtration rate (eGFR) was measured before and after lithium discontinuation.

Main Results:

  • The eGFR slope significantly improved after lithium discontinuation.
  • The majority of patients with chronic kidney disease (eGFR < 60 ml/min) experienced an eGFR increase or a reduced rate of decline.
  • Patients with further renal function deterioration had a significantly lower mean eGFR (32 ml/min) compared to those who improved.

Conclusions:

  • Discontinuation of lithium therapy results in improved renal function for the majority of patients.
  • In many cases, stopping lithium therapy leads to less rapid deterioration of kidney function.