Renal Insufficiency in Long-Term Lithium Treatment

Lepkifker, Elie; Sverdlik, Anna; Iancu, Iulian; R, Ziv; Segev, Shlomo; Kotler, Moshe

doi:10.4088/jcp.v65n0618

Cited by 95 publications

(70 citation statements)

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“…37) Chronic tubulointerstitial nephropathy associated with cortical and medullary tubular cysts or dilation have been observed during lithium therapy. 38) The results of our study are consistent with the previous finding of Lepkifker et al 18) in which renal insufficiency in long term lithium treatment has also been reported.…”

Section: Discussionsupporting

confidence: 83%

“…16,17) Renal insufficiency in long term lithium treatment has also been reported recently. 18) This is an endeavor to study the histopathological and biochemical impacts of intake of small doses of lithium nitrate on renal tissue along with some blood parameters in male albino rats. Our results suggest that small doses of lithium induces toxicity in rats and therefore, studies evaluating its long-term tolerability are important.…”

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confidence: 99%

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Lithium Induced Toxicity in Rats: A Hematological, Biochemical and Histopathological Study

Sharma

Iqbal

2005

Biological & Pharmaceutical Bulletin

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The effect of long-term lithium treatment on renal function has been a matter of concern for about a quarter of centaury and remains controversial. For the last five decades researchers have been paying much attention to the lithium salts due to their therapeutic uses in controlling a variety of neurotic and psychosomatic manic depressions, neurotoxicity, affecting muricidal behavior and lithium sickness. [1][2][3][4] Extensive usage of lithium and its compounds in pharmaceuticals, dehumidifying and air conditioning units, ceramics and metallurgical processes, lubricants and in a number of chemical and biological laboratories brings this lightest alkali metal in close contact of human.Toxicity of lithium may be caused while taken as medicine. 5,6) Lithium salts cause ocular side effects, 7) polyuria, polydipsia, loss of body mass 8) and impaired renal concentration capacity after water deprivation.9) Lithium salts used as medicine can readily cross the placental barriers and produce teratogenic effects and toxicity. 10) In early pregnancy, lithium salt therapy elicited to be associated with a several fold increase in the incidence of cardiovascular anomalies in newborn, including tricuspid valve abnormalities.11) Cerebellar atropic changes related to lithium therapy 12) and peri-follicular inflammation and follicular plugging 13) even with the therapeutic limit of lithium level of blood have been observed. The occurrences of choreoathetosis 14) and abnormalities in lung and respiratory tract have also been reported by intake of lithium.15) Hypochromic microcytic anemia, hypercholesterolaemia, hyperglycemia, glycogenolysis, disturbance in TCA cycle and stimulation in transamination reaction in liver and kidney following repeated intramuscular injections of lithium nitrate in laboratory animals have been reported previously. 16,17) Renal insufficiency in long term lithium treatment has also been reported recently.18) This is an endeavor to study the histopathological and biochemical impacts of intake of small doses of lithium nitrate on renal tissue along with some blood parameters in male albino rats. Our results suggest that small doses of lithium induces toxicity in rats and therefore, studies evaluating its long-term tolerability are important. MATERIALS AND METHODS ChemicalsLithium nitrate, sodium citrate, diethylbarbiturate, 3,5-dinitrosalicilate, ammonium molybdate, citric acid, diacetylmonoxime, b sodium glycero phosphate, a ketoglutarate, a L-alaline, L-aspartate, sodium hypochlorite, trichloroacetic acid, and dinitrophenyl hydrazine were purchased from Sigma Chemical Company (St Louis, MO, U.S.A.). All other chemicals and reagent used were either of analytical grade or of highest purity, commercially available.Animals and Treatments Animals experiments were approved by animal care committee of Jamia Hamdard, care and handling of animals were in accordance with Indian Council of Medical Research guidelines. Male albino wistar rats (4-6 weeks) weighing 125-150 g, from Jamia Hamdard Central Animal House Col...

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Section: Discussionsupporting

confidence: 83%

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confidence: 99%

Lithium Induced Toxicity in Rats: A Hematological, Biochemical and Histopathological Study

Sharma

Iqbal

2005

Biological & Pharmaceutical Bulletin

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“…La implicación clínica de este hallazgo consistiría en que a mayor tiempo de tratamiento mayor es la posibilidad de que ocurra una intoxicación por litio (31). Sin embargo, estudios más recientes, han revelado que el daño progresivo que ocurre a nivel de la función glomerular y tubular, podría estar relacionada más bien con otros factores como una intoxicación por litio ocurrida en algún momento del tratamiento, el mantenimiento de altos niveles de litio en plasma, interacciones medicamentosas, otras enfermedades somáticas y la edad, más que con el tiempo de tratamiento con litio, por lo que habría que controlar todas estas variables (32,33). Estas dos opiniones nos muestran que la causa del daño renal durante el tratamiento con litio, es un punto que continúa generando controversia y no está nada claro en este momento.…”

Section: Farmacologíaunclassified

Intoxicación con litio

Ortega

Medina-Ortiz

García-Armenter

2006

An. Med. Interna (Madrid)

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INTRODUCCIÓNEl litio, es uno de los fármacos clásicos, que ha demostrado desde hace varias décadas, ser efectivo en el control de la excitación que se produce en los pacientes con episodios maníacos (1,2) y, en la prevención de nuevas crisis en los pacientes con trastorno bipolar (TB) (3,4). Sin embargo, la intoxicación con litio es una complicación frecuente cuando se administra a largo plazo en pacientes con trastornos del estado del ánimo. Aún con pequeñas elevaciones de litio séri-co, estos pacientes tienen una alta probabilidad de manifestar síntomas y signos de intoxicación grave comparados con pacientes que sufren una intoxicación aguda con niveles similares de litio en sangre, ya que, en una intoxicación aguda, los niveles de litio informados no se correlacionan directamente con los niveles en los tejidos, los cuales son mayores en pacientes que han recibido litio a largo plazo. Debido a esto, la toxicidad crónica se puede llegar a dar con bajas dosis de litio, en pacientes que llevan un tratamiento de varios años de evolución (5).Desde 1949, cuando Cade (6,7), introdujo las sales de litio para el manejo de la manía, son varios los casos de intoxicación por litio que se han informado (5,8,9). A mediados del siglo XIX, el litio era utilizado como la panacea para muchas afecciones comunes, por la comunidad médica, pero su alta toxicidad llevó a que el tratamiento con litio fuera prohibido en los Estados Unidos hasta 1970, cuando fue aprobado por la FDA (10) y, en 1974 se aprobó como terapia de mantenimien- [0212-7199 (2006) RESUMENLa intoxicación aguda por litio no es frecuente, entre el 75% al 90% de los pacientes con terapia de mantenimiento de litio pueden haber mantenido niveles tóxicos durante su tratamiento. La dosis por debajo de 2,5 mmol/L no suelen asociarse a la aparición de síntomas. Los sistemas más afectados son el neurológico, gastrointestinal y cardiovascular. Los sínto-mas aparecen desde las dos y las cuatro horas postingesta. En las horas posteriores a la ingestión de litio, los niveles de litio no reflejan la severidad del cuadro clínico, no obstante la monitorización hormonal es importante para dirigir la agresividad terapéutica y marcar el pronóstico del cuadro. La utilización de forzar diuresis con solución salina isotópica, son mencionadas por diversos autores. Entre otras opciones también descritas está la diálisis.En resumen, la intoxicación por litio puede ser un cuadro potencialmente frecuente y grave, por ello es necesario escribir unas normas de manejo terapéutico de esta entidad.

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“…In a retrospective study, 21% of the sample under lithium developed some degree of renal impairment 66 . Both the duration of treatment as well as the blood levels did not influence the development of renal failure.…”

Section: Renal Impairmentmentioning

confidence: 99%

“…Several studies between the 1980s and 1990s showed no significant change in GFR or just a slight functional deterioration with the use of lithium in the long-term follow-up 43,[58][59][60][61][62][63] . However, five more recent studies reported that between 21 and 55% of patients treated with lithium presented a GFR of less than 60 ml/min/1.73 m 2 , corresponding to the cutoff for the third stage of renal disease [64][65][66][67][68][69] . A recent systematic review selected 23 studies that investigated the effect of the use of lithium on renal function, dividing them into three categories: cross-sectional case-control studies, pre and post-lithium treatment studies, and observational long-term studies 10 .…”

Section: Renal Impairmentmentioning

confidence: 99%

Lithium safety and tolerability in mood disorders: a critical review

Aprahamian¹,

Sousa²,

Valiengo³

et al. 2014

Rev. psiquiatr. clín.

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Background: Lithium is a first-line treatment for bipolar disorder in all phases, also indicated as add-on drug for unipolar depression and suicide prevention. This study encompasses a broad critical review on the safety and tolerability of lithium for mood disorders. Methods: A computerized search for English written human studies was made in MEDLINE, using the keywords "lithium" and "mood disorders", starting from July 1993 through July 2013 (n = 416). This initial search aimed to select clinical trials, prospective data, and controlled design studies of lithium treatment for mood disorders reporting adverse effects (n = 36). The final selection yielded 91 studies. Results: The most common general side effects in patients on lithium treatment were thirst, frequent urination, dry mouth, weight gain, fatigue and cognitive complaints. Lithium users showed a high prevalence of hypothyroidism, hyperparathyroidism, and decrease in urinary concentration ability. Reduction of glomerular filtration rate in patients using lithium was also observed, but in a lesser extent. The evidence of teratogenicity associated with lithium use is not well established. Anti-inflammatory non-steroidal drugs, thiazide diuretics, angiotensin-converting enzyme inhibitors, and alprazolam may increase serum lithium and the consequent risk for intoxication. Discussion: Short-term lithium treatment is associated with mild side effects. Medium and long-term lithium treatment, however, might have effects on target organs which may be prevented by periodical monitoring. Overall, lithium is still a safe option for the treatment of mood disorders.

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Renal Insufficiency in Long-Term Lithium Treatment

Cited by 95 publications

References 0 publications

Lithium Induced Toxicity in Rats: A Hematological, Biochemical and Histopathological Study

Lithium Induced Toxicity in Rats: A Hematological, Biochemical and Histopathological Study

Intoxicación con litio

Lithium safety and tolerability in mood disorders: a critical review

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