Lithium nephrotoxicity

Azab, Abed N.; Shnaider, Alla; Osher, Yamima; Wang, Dana; Bersudsky, Yuly; Belmaker, Robert H.

doi:10.1186/s40345-015-0028-y

Cited by 70 publications

(74 citation statements)

References 43 publications

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“…Proposed risk factors for the renal effects leading to polyuria/polydipsia include: duration of treatment, higher serum lithium levels, repeated episodes of lithium intoxication and the ingestion of other psychotropic medications, especially antipsychotics (Gitlin 1999; Azab et al 2015). …”

Section: Resultsmentioning

confidence: 99%

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Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

387

301

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Despite its virtually universal acceptance as the gold standard in treating bipolar disorder, prescription rates for lithium have been decreasing recently. Although this observation is multifactorial, one obvious potential contributor is the side effect and toxicity burden associated with lithium. Additionally, side effect concerns assuredly play some role in lithium nonadherence. This paper summarizes the knowledge base on side effects and toxicity and suggests optimal management of these problems. Thirst and excessive urination, nausea and diarrhea and tremor are rather common side effects that are typically no more than annoying even though they are rather prevalent. A simple set of management strategies that involve the timing of the lithium dose, minimizing lithium levels within the therapeutic range and, in some situations, the prescription of side effect antidotes will minimize the side effect burden for patients. In contrast, weight gain and cognitive impairment from lithium tend to be more distressing to patients, more difficult to manage and more likely to be associated with lithium nonadherence. Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild. A small but measurable percentage of lithium-treated patients will show progressive renal impairment. Infrequently, lithium will need to be discontinued because of the progressive renal insufficiency. Lithium-induced hypothyroidism is relatively common but easily diagnosed and treated. Hyperparathyroidism from lithium is a relatively more recently recognized phenomenon.

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Section: Resultsmentioning

confidence: 99%

“…Thus, an older person may have substantially diminished eGFR but a relatively normal serum creatinine.) Polyuria correlates only weakly with reduced kidney function with the former rather common and the latter unusual (Azab et al 2015). …”

Section: Lithium and The Kidneysmentioning

confidence: 99%

Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

387

301

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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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“…Degenerative processes in older persons contribute to functional decline in all systems including the kidneys,7 within which sclerotic changes becomes the culprit in causing renal failure8 and chronic kidney disease 9. Apart from advanced age, duration of lithium treatment is an added risk factor for reduced glomerular filtration rate (GFR) and the subsequent deterioration of renal function 10.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive bipolar: chronic lithium toxicity in patients taking ACE inhibitor

Masiran

Aziz

2017

BMJ Case Reports

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A patient with bipolar I disorder has been treated with lithium and haloperidol for the last 20 years and received an ACE inhibitor for his hypertension since 9 years ago. Despite regular clinic follow-ups and blood monitoring, he recently developed tremors and delirium. On hospital admission, serum level of lithium was far above toxic level. Mental state examination revealed an anxious and disorientated man with irrelevant speech. Immediate discontinuation of lithium resulted in slow reduction of serum lithium levels and gradual resolution of tremor but his delirium persisted for 2 weeks. His condition took a turn for the worse when he developed acute renal failure and arm abscess. We discussed about lithium toxicity and the vulnerability factors which have induced delirium and renal failure in this patient.

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Lithium nephrotoxicity

Cited by 70 publications

References 43 publications

Lithium side effects and toxicity: prevalence and management strategies

Lithium side effects and toxicity: prevalence and management strategies

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

Hypertensive bipolar: chronic lithium toxicity in patients taking ACE inhibitor

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