[Lithium and renal function (author's transl)]

Reviewing the literature on the effect of lithium on renal function, the authors summarize the mechanisms involved in the concentration and elimination of lithium by this organ, as well as the urinary modifications in ionic exchanges and concentration capacity induced by this metal. After having mentioned the different factors influencing lithium clearance, the authors emphasize that diuretics should be used with caution with lithium and examine critically the various publications on the eventual nephrotoxicity of this agent. Although they conclude that there is no absolute proof of renal toxicity, they suggest for the time being to consider lithium intoxications and lithium-induced insipid diabetes, without ruling out lithium treatment itself, as risk factors of renal insufficiency. Their importance still needs further evaluation and requires, before and during treatment with this drug, a monitoring of the renal function, some essential element of this surveillance being proposed.