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Renal function in patients receiving long-term lithium therapy

P R Uldall, A G Awad, W O McCormick

    Canadian Medical Association Journal
    |June 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

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    Lithium treatment in stable outpatients can impair kidney function, specifically urine concentration ability in most patients and creatinine clearance in some. These lithium-induced kidney changes are generally self-limiting and not progressive.

    Area of Science:

    • Nephrology
    • Pharmacology
    • Internal Medicine

    Background:

    • Lithium is a widely used mood stabilizer for bipolar disorder.
    • Long-term lithium therapy can affect renal function.
    • Understanding the prevalence and nature of lithium-induced renal effects is crucial for patient management.

    Purpose of the Study:

    • To assess renal function in stable outpatients undergoing long-term lithium therapy.
    • To identify specific patterns of kidney impairment associated with lithium treatment.
    • To evaluate the potential progression and clinical significance of these renal changes.

    Main Methods:

    • Cross-sectional study of 42 stable outpatients on lithium therapy for an average of 4.5 years.
    • Assessment of renal function included urine osmolality measurements, creatinine clearance, and urine microscopy.

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  • Analysis of the prevalence of impaired urine concentrating ability and reduced creatinine clearance.

    • Main Results:

    • 61% of patients (41/41) exhibited impaired urine concentrating ability.
    • 12% of patients (5/42) showed a moderate reduction in creatinine clearance.
    • Urine microscopy revealed excess cells in 40% of patients.
    • One patient presented with both impaired urine concentration and reduced creatinine clearance.

    Conclusions:

    • Long-term lithium therapy is associated with a high prevalence of impaired urine concentrating ability.
    • A smaller proportion of patients experience reduced creatinine clearance.
    • Lithium appears to cause a self-limiting distal nephron lesion that rarely progresses to chronic renal failure but may increase susceptibility to neurotoxicity during illness or dehydration.