Renal side effects of long-term lithium therapy

Lithium is widely used in the treatment of bipolar disorders. Long-term administration of lithium often leads to side effects concerning the subjects: nephrology, endocrinology and surgery. This review emphasizes nephrotoxicity. Lithium treatment may disturb responsiveness to antidiuretic hormone (ADH), causing a nephrogenic diabetes insipidus. Furthermore long-term lithium therapy may trigger hyperparathyreoidism with hypercalcemia and chronic interstitial nephritis with development of microcysts. Long-term patients have an increased risk to develop impaired renal function. Lithium-induced endstage renal disease is rare. Termination of lithium treatment may decrease the risk of progression. To ensure security of lithium treatment regular controls of urine osmolarity, lithium-, creatinine-, thyroid stimulating hormone- and calcium-levels are essential. Patients with decreased renal function should be referred to a specialist early. © Georg Thieme Verlag KG Stuttgart New York.