Lithium: long‐term effects on the kidney I. Renal function in retrospect

Abstract

46 patients treated with lithium for an average of 8 years participated in a functional-morphological follow-up study based on a 12-day hospitalization and involving a kidney biopsy. The functional part of the study showed that tubular function was markedly influenced, leading to increased urine volume (average 3 1/24 h) and a decreased renal concentration capacity in 85% of the patients. Glomerular function was generally not influenced, and only 10% of the patients had glomerular filtration rates below their age-corrected normal ranges. Both urine volume and glomerular filtration rates showed significant correlations with dosage schedule. Urine volume was lower and glomerular filtration rate higher on a one-dose schedule than when lithium was given in divided doses during the day. It is concluded that discontinuity in lithium treatment minimizes lithium effects on kidney function.

Review: Meta-analysis of the effects of lithium usage on serum creatinine levels

“…The remaining two studies, Hetmar, et al (1986) and Povlsen, et al (1992), show a statistically significant rise in serum creatinine measurements in the first few years of lithium treatment. This difference cannot be accounted for on the basis of differences in subject age or follow-up periods between studies.…”

Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus

“…[62][63][64] Reports of NDI among patients treated with lithium vary widely but the incidence of this adverse effect has been reported to be as high as 85%. 63,65 As 0.25-0.77% of the general population aged >65 years are prescribed lithium, it is not surprising that lithium-induced NDI is fairly commonly. 66,67 Indications for lithium treatment include bipolar disorder, schizoaffective disorder, depression, alcoholism and cluster headaches.…”

From BALANCE to DSM‐5: taking lithium seriously

“…Patients need to be educated about the many benefits of lithium, including two other major areas, besides mood prophylaxis: mortality reduction, both by suicide and by cardiovascular death, and neuroprotective effects, especially probable reduction of dementia risk and potential protection against the cognitive impairment that is a long‐term consequence of multiple mood episodes (1). The drawbacks of lithium are well known, though exaggerated: long‐term chronic renal insufficiency, in the best prospective studies with decades of follow‐up, is not more than 5% (8); other kidney effects, like decreased urinary concentration capacity, are more common but reversible and not medically dangerous; hypothyroidism is more common but treatable and reversible; nuisance side effects are less frequent than many believe; weight gain is less than with valproate and much less than most neuroleptics; cognitive side effects are problematic in some, but not most persons, and counteracted by long‐term cognitive benefits; toxicity in overdose is a risk but this is the only drug that is proven to prevent suicide by a huge effect size (estimated to be nine‐fold decreased risk) (1).…”