Lithium nephropathy

Lithium nephropathy

Lithium nephropathy is a renal lesion caused by lithium preparations. Acute lithium poisoning can present psychiatric, neurological and muscular symptoms, including apathy, slow reaction, tremors, rigidity and ataxia, and may occur in conscious disturbances and coma. Acute lithium poisoning can cause acute renal failure and multiple renal lesions, including chronic tubulointerstitial disease, renal dysfunction, diabetes insipidus and concentrated incomplete distal renal tubular acidosis, qualitative disease, distal tubule formation of tubule vesicles.

Earlier reports of chronic renal damage caused by lithium preparations were observed in 1977. The incidence of this disease is unknown. Over 50% of patients who have been treated with lithium for a long time have ADH resistant urine concentrating dysfunction. Around 20% of the cases can have polyuria. 85% patients with long-term lithium therapy had normal GFR, 15% had mild GFR impairment, and significant GFR reductions were seen only in patients treated with lithium for more than 10~15 years.

The disease is mainly symptomatic treatment. Polyuria and polydipsia caused by renal diabetes insipidus, as well as other acute manifestations of lithium damage to the kidneys, usually disappear rapidly after discontinuation of the lithium preparation. In the treatment of psychosis with lithium preparations, we should consider two aspects: effective control of psychosis and avoidance of side effects. Polyuria can be used as an indicator of the side effects of lithium preparations. Attention should be paid to the serum lithium concentration. When lithium concentration is too high or lithium toxicity occurs repeatedly, it is prone to renal damage. The principle of treatment of lithium nephropathy patients, like other toxic nephropathy, should promptly stop the drug, symptomatic support treatment, severe renal failure treatment, according to renal failure treatment.

 

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