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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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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.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Antihypertensive Drugs: Potassium-Sparing Diuretics01:28

Antihypertensive Drugs: Potassium-Sparing Diuretics

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Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
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Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Renal Drug Excretion: Effect of Urine pH, Flow Rate, and Drug pKa01:22

Renal Drug Excretion: Effect of Urine pH, Flow Rate, and Drug pKa

166
The pH of urine, the drug's pKa, and the urine flow rate are vital parameters for drug reabsorption and excretion. Urinary pH varies between 4.6 and 8.0 and is influenced by diet, drug intake, and the patient's pathophysiology. It affects a drug's ionization state and reabsorption. For instance, carbohydrate-rich food produces alkaline urine promoting drug excretion, while proteins and certain medications like ascorbic acid lead to acidic urine enhancing reabsorption.
The pKa of a...
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Mania and Antimanic Drugs: Overview01:24

Mania and Antimanic Drugs: Overview

174
Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
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Updated: Jun 27, 2025

5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
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Lithium-Associated Kidney Failure: Predictors and Outcomes.

Emily Qian1, Kamal Sud2,3, Vincent Lee4,5,6

  • 1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Kidney International Reports
|May 6, 2024
PubMed
Summary

Patients with lithium-associated kidney failure are older, female, European, and have higher socioeconomic status but fewer comorbidities. Despite these unique characteristics, survival rates on kidney replacement therapy (KRT) are similar to other patients.

Keywords:
kidney replacement therapykidney transplantationlithium nephrotoxicitylithium-associated kidney failureoutcomespredictors

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Area of Science:

  • Nephrology
  • Pharmacology
  • Public Health

Background:

  • Lithium is widely prescribed for bipolar disorder and depression.
  • Characteristics and outcomes of patients with lithium-associated kidney failure on kidney replacement therapy (KRT) are poorly understood.

Purpose of the Study:

  • To investigate the predictors and outcomes of patients with lithium-associated kidney failure receiving KRT.
  • To compare the cohort of patients with lithium-associated kidney failure to patients with kidney failure not associated with lithium.

Main Methods:

  • Retrospective study utilizing the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA).
  • Comparison of 437 patients with lithium-associated kidney failure against 1280 control patients with non-lithium-associated kidney failure.

Main Results:

  • Patients with lithium-associated kidney failure were older, more likely to be European and female, and from higher socioeconomic status backgrounds.
  • This cohort exhibited lower rates of major comorbidities including coronary artery disease, peripheral vascular disease, cerebrovascular disease, and diabetes mellitus.
  • While KRT modality initiation was similar, kidney transplantation and retransplantation rates were lower in the lithium-associated group, despite shorter wait times for initial transplantation. No survival differences were observed between groups.

Conclusions:

  • Lithium-associated kidney failure defines a distinct patient cohort with specific demographic and comorbidity profiles.
  • Despite these differences, survival outcomes on KRT are comparable to patients without lithium exposure.
  • Lower transplantation rates in this cohort warrant further investigation into potential barriers to kidney transplantation.