HDCN Article Review/Hyperlink

Bendz H, Sjodin I, Aurell M

Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium withdrawal study.

Nephrol Dial Transplant (Mar) 11:457-460 1996

Controversy around the long term nephrotoxic effects of lithium continues with conflicting results from observational studies.This case-control prospective study compared renal function in 13 patients who had been on lithium for at least 15 years, and at 5 and 9 weeks after stopping treatment, with 13 controls with an affective disorder not treated with lithium and who were matched for age and sex. Serum lithium values before 1977 were unreliable and mean serum lithium concentration after that period was 0.66 (0.30 - 0.90) meq/l.The results show no differences in serum creatinine (lithium patients on lithium, mean ( SEM (range) 103 ( 6 (mol/l (73-161), off lithium 97 ( 7 (73-163), controls 86 ( 4 (66-108), or GFR (lithium patients on lithium 69 ( 4 ml/min/1.73m2 (39-96), off lithium 74 ( 4 (39-94), controls 78 ( 4 (61-106). Urine osmolality remained significantly lower in the lithium patients compared to controls. The authors interpret their data to suggest that lithium therapy is followed by an irreversible impairment of urinary concentrating ability, whereas GFR does not appear to be adversely affected.

Comment: This small study does not have the power to detect even a 50% reduction in renal function in these patients and the period of follow-up after withdrawal is too short for any useful conclusion to be drawn. Other studies support the view that urine concentrating ability may be permanently impaired after many years of lithium treatment. The long term effects on GFR remain uncertain. (C.P. Swainson, M.D., Royal Infirmary of Edinburgh, Scotland)