Lithium Nephropathy Follow-up

Updated: Jan 18, 2022
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Follow-up

Further Outpatient Care

Some reports recommend testing the patient's renal-concentrating ability, 24-hour urinary volume, and creatinine clearance before initiating lithium therapy and at 1-year intervals.

Schou recommends regular measurements of serum lithium and creatinine every 2-6 months and obtaining serum thyroid-stimulating hormone determinations once a year. [38]

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Further Inpatient Care

Patients with severe cases of volume depletion with associated electrolyte abnormalities (ie, hypernatremia) may require ICU care.

Once aggressive diuresis is initiated or dialysis is performed for acute toxicity, lithium levels should be sequentially checked to ensure that rebound toxic levels and/or delayed gastrointestinal absorption leading to recurrent toxicity do not occur.

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Deterrence/Prevention

A systematic review by Schoot et al found found very limited evidence on prevention of lithium-induced nephrogenic diabetes insipidus and lithium nephropathy, but recommended using a once-daily dosing schedule and targeting the lowest serum lithium level that is effective. Lithium has a low therapeutic index; monitor levels closely to prevent acute lithium intoxication and identify diabetes insipidus or nephropathy promptly, because early diagnosis and treatment can prevent further progression and permanent damage. [39]

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Complications

Some reports have linked acute kidney injury to lithium intoxication. In these cases, however, researchers did not exclude decreased perfusion and other causes of volume depletion as possible contributing factors. Nevertheless, physicians must remember that lithium intoxication can cause volume depletion and vice versa.

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Prognosis

Patients with urine-concentrating defects from lithium treatment usually take weeks to months to recover following discontinuation of lithium. In rare situations, the problem can persist for years.

Acute kidney injury associated with lithium toxicity has an excellent prognosis.

Chronic kidney disease associated with lithium use only uncommonly will completely resolve but generally will not progress if the medication is discontinued and other nephrotoxic agents, such as nonsteroidal anti-inflammatory drugs, or hypertension are minimized.

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