Lithium Nephropathy Follow-up

Updated: Dec 14, 2016
  • 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.

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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

Lithium has a low therapeutic index; monitor levels closely to prevent acute lithium intoxication.

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Complications

Some reports have linked acute renal failure 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 renal failure associated with lithium toxicity has an excellent prognosis.

Chronic renal failure 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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