2017 issue 3-4


Volume 33, issue 3-4

Original article

Five-year observation of chronic renal insufficiency during lithium treatment. A case study of four patients

Maria Abramowicz1, Agnieszka Permoda-Osip1, Barbara Nowak1, Paweł Olejniczak2, Janusz K. Rybakowski1,3
1. Klinika Psychiatrii Dorosłych, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
2. Klinika Nefrologii, Transplantologii i Chorób Wewnętrznych, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
3. Klinika Psychiatrii Dzieci i Młodzieży, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 169–179
Date of publication: 30-01-2018
DOI: http://dx.medra.org/10.17393/fpn.2017.12.006
Keywords: bipolar disorder, lithium, kidney


Objectives. The most frequent renal side-effect of lithium is an impairment of concentrating ability and, after 10–20 years, a chronic tubular-interstitial nephropathymay occur in some patients. Discontinuation of lithium, especially in "excellent lithium responders" (ELR), is associated with a high risk of relapse and a treatment-resistant course. The purpose of the study was to assess kidney function during a five-year follow-up in the ERL with the glomerular filtration rate (GFR) < 50 ml/min/1.73 m2.

Material and methods. Three males and one female were included. At the beginning their age was 61 ± 0.8 years and duration of lithium treatment was 27 ± 9 years. Kidney parameters (serum creatinine, GFR, and urine specific gravity) were assessed at least three times during the five-year follow-up period.

Results. The patients examined had the mean change of GFR of –2.5 ± 7.7%, serum creatinine –0.5 ± 7.3%, and urine specific gravity of 0.0025 ± 0.0041 g/ml. In three patients having the initial GRF between 47–48 ml/min/1.73 m 2 , the kidney parameters did not show significant changes and the patients continued lithium treatment as previously. The patient with the lowest GFR (32 ml/min/1.73 m 2 ) had a 14% decrease in GFR and a 10% increase in serum creatinine. The dose of lithium was decreased by one-third and he was placed under strict nephrological observation.

Conclusions. Based on the results and in the ELR with the GFR not much lower than 50 ml/min/1.73 m 2 , we suggest continuing lithium with a yearly check on kidney parameters. In the ELR with a much lower GFR, a reduction of lithium dose, and nephrological observation along with more frequent monitoring would be recommended.

Address for correspondence:
Maria Abramowicz
Klinika Psychiatrii Dorosłych, Uniwersytet Medyczny
im. Karola Marcinkowskiego w Poznaniu
ul. Szpitalna 27/33, 60-572 Poznań, Poland
phone: +48 782 663 564, email: mariaabramowicz@tlen.pl