2016 issue 3

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Volume 32, issue 3

Review article

Long-term lithium treatment and the occurrence of renal tumors – literature review and case report

Maria Aleksandra Abramowicz1, Katarzyna Jończyk-Potoczna2, Janusz Rybakowski1
1. Uniwersytet Medyczny w Poznaniu, Klinika Psychiatrii Dorosłych
2. Uniwersytet Medyczny w Poznaniu, Szpital Kliniczny im. K. Jonschera, Zakład Radiologii Pediatrycznej UM
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 181–191
Date of publication: 21-11-2016
DOI: http://dx.medra.org/10.17393/fpn.2016.09.003
Keywords: lithium, kidney, renal tumor

Abstract

Lithium, a mood-stabilizing drug, has been employed in psychiatry for nearly 70 years. Its use can result in an impairment of urine-concentrating ability and, with long-term administration, can lead to chronic tubular-interstitial nephropathy. Lithium induces cell proliferation in the kidneys, especially in the collecting ducts, resulting in tubular dilatation and the formation of cysts, as shown during imaging examinations in patients on long-term lithium treatment. In recent years, reports have appeared concerning an increased risk of renal tumors in lithium-treated patients with bipolar disorder (BD). The results of a study by French researchers published in 2014 suggested a manifold increased risk of kidney cancer in patients receiving long-term lithium treatment. The study was criticized and commented upon on by psychiatrists who have observed no such relationship in their clinical experience. In the last two years the results of three large population studies have been published (two performed in Denmark, one in Sweden); these have demonstrated that long-term lithium treatment is not connected with an increased risk of renal and upper urinary tract tumors. In this paper, the case of a 56-year female BD patient is reported. She has been receiving lithium for more than 10 years, during which time (2011) an ultrasonographic examination detected a tumor of 5×5×4.5 cm in her left kidney. Normal indices of kidney function suggested that the tumor was not associated with the lithium treatment. The tumor was surgically removed without necessity of further treatment. Histopathological examination pointed to carcinoma papillare. The patient has continued with the lithium treatment since the removal of the tumor, to good effect.

Address for correspondence:
Maria Abramowicz
Uniwersytet Medyczny w Poznaniu
Klinika Psychiatrii Dorosłych
ul. Szpitala 27/33
60-672 Poznań
Poland
phone: +48 782 663 564
email: mariaabramowicz@tlen.pl