Lithium in the Kidney: Friend and Foe?

Alsady, Mohammad; Baumgarten, Ruben; Deen, Peter M.T.; Groot, Theun de

doi:10.1681/asn.2015080907

Cited by 68 publications

(55 citation statements)

References 117 publications

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“…Much of this reabsorption must be transcellular. The lithium‐transporting pathway is not known, but is thought to be the sodium–hydrogen exchanger NHE3, which can be blocked by amiloride at concentrations of >50–100 μmol . It is possible therefore that lithium could enter the proximal tubular cells via NHE3 and leave through the basolateral action of NHE1.…”

Section: Discussionmentioning

confidence: 99%

“…The lithium-transporting pathway is not known, but is thought to be the sodium-hydrogen exchanger NHE3, which can be blocked by amiloride at concentrations of >50-100 μmol. 23 It is possible therefore that lithium could enter the proximal tubular cells via NHE3 and leave through the basolateral action of NHE1. Although NHE3 has a low affinity for lithium, it may be sufficient to disrupt cellular metabolism and lead to a release of Wnt1 ligands, in turn activating interstitial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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Amiloride modifies the progression of lithium‐induced renal interstitial fibrosis

et al. 2017

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ABSTRACT:Aim: Long-term administration of lithium has been associated with the development of a chronic interstitial fibrosis in addition to nephrogenic diabetes insipidus (NDI). Earlier studies have demonstrated that amiloride, by blocking the epithelial sodium channel ENaC and thus preventing lithium uptake into the principal cells of the collecting ducts, can partially reverse lithium-induced NDI. However, there are no long-term studies examining whether or not amiloride also modifies the progressive chronic interstitial fibrosis and tubular atrophy often evident with long term lithium exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Amiloride modifies the progression of lithium‐induced renal interstitial fibrosis

et al. 2017

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“…Adverse effects with regard to renal and thyroid function frequently occur . A significant decline in renal function has been reported in patients treated with lithium, in rare cases resulting in renal failure . Thyroid function may decline, with a risk of developing goiter.…”

Section: Introductionmentioning

confidence: 99%

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

et al. 2019

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Objectives Laboratory monitoring of patients using lithium is important to prevent harm and to increase effectiveness. The aim of this study is to determine compliance with the guidelines for laboratory monitoring of patients treated with lithium overall and within subgroups. Methods Patients having at least one lithium dispensing for 6 months or longer between January 2010 and December 2015 were identified retrospectively using data from the Dutch PHARMO Database Network. Laboratory monitoring was defined as being compliant with the Dutch Multidisciplinary Clinical Guideline Bipolar Disorders when lithium serum levels, creatinine and thyroid‐stimulating hormone (TSH) had been measured at least every 6 months during lithium use. Results Data were analyzed from 1583 patients with a median duration of 7‐ to 6‐months period of lithium use. Results indicated that patients had been monitored over 6‐month period for lithium serum levels 65% of the time, for creatinine 73% of the time and for TSH 54% of the time. Just over one seventh (16%) of patients had been monitored in compliance with the guidelines for all three parameters during total follow‐up. Especially males, patients aged below 65 years, patients receiving prescriptions solely from general practitioners, prevalent users of lithium, patients without interacting co‐medication, and patients without other days with laboratory measurements had been monitored less frequently in compliance with the guidelines. Conclusions A considerable proportion of patients had not been monitored in accordance with the guidelines. Further research is needed to understand the reasons for noncompliance and to implement strategies with the ultimate goal of optimizing safety and effectiveness for patients treated with lithium.

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“…Both schizophrenia and bipolar disorder showed associations with common and strong risk factors of chronic kidney disease (CKD) such as diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disease . In addition, treatment of bipolar disorder with lithium has a strong association with the development and worsening of CKD .…”

Section: Introductionmentioning

confidence: 99%

History of psychosis and mania, and outcomes after kidney transplantation - a retrospective study

et al. 2018

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History of psychosis or mania, if uncontrolled, both represent relative contraindications for kidney transplantation. We examined 3680 US veterans who underwent kidney transplantation. The diagnosis of history of psychosis/mania was based on a validated algorithm. Measured confounders were used to create a propensity score-matched cohort (n = 442). Associations between pretransplantation psychosis/mania and death with functioning graft, all-cause death, graft loss, and rejection were examined in survival models and logistic regression models. Post-transplant medication nonadherence was assessed using proportion of days covered (PDC) for tacrolimus and mycophenolic acid in both groups. The mean ± SD age of the cohort at baseline was 61 ± 11 years, 92% were male, and 66% and 27% of patients were white and African-American, respectively. Compared to patients without history of psychosis/mania, patients with a history of psychosis/mania had similar risk of death with functioning graft [subhazard ratio (SHR) (95% confidence interval (CI)): 0.94(0.42-2.09)], all-cause death [hazard ratio (95% CI): 1.04 (0.51-2.14)], graft loss [SHR (95% CI): 1.07 (0.45-2.57)], and rejection [odds ratio(95% CI): 1.23(0.60-2.53)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of psychosis/mania (PDC: 76 ± 21% vs. 78 ± 19%, P = 0.529 for tacrolimus; PDC: 78 ± 17% vs. 79 ± 18%, P = 0.666 for mycophenolic acid). After careful selection, pretransplantation psychosis/mania is not associated with adverse outcomes in kidney transplant recipients.

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Lithium in the Kidney: Friend and Foe?

Cited by 68 publications

References 117 publications

Amiloride modifies the progression of lithium‐induced renal interstitial fibrosis

Amiloride modifies the progression of lithium‐induced renal interstitial fibrosis

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

History of psychosis and mania, and outcomes after kidney transplantation - a retrospective study

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