Lithium nephropathy
Introduction
Chronic use of lithium in patients with mood disorders are associated with various forms of renal injury. Nephrogenic diabetes insipidus is the most common renal side effect of lithium treatment. In addition, lithium use cause chronic interstitial nephritis (CIN) and in rare cases could lead to kidney failure in end stage. Clinical presentation
40% of lithium users will develop a reduced ability to concentrate urine and a smaller number will develop renal diabetes insipidus. Lithium use can affect ADH sensitivity in headers and weaken the responsiveness of ADH. Reduced presentation of aquaporin luminal will therefore cause impaired ability to concentrate urine. The changes may be irreversible after prolonged use. Nocturia with lithium use to give suspected condition. Renal tubular acidosis can also occur due to defect in the distal portions of nephrons. Chronic interstitial nephritis is also a known late effect of lithium use, disease presentation and histopathological findings include that the second CIN. (see chronic interstitial nephritis). In addition, even nephrotic syndrome with histopathological findings with minimal change nephropathy FSGS related to lithium use. The mechanisms behind this are poorly understood. Course and treatment
Lithium is often necessary treatment for the mental disorder due. It is therefore not always advisable to discontinue the drug even if it is desired. Further treatment should be discussed with the attending psychiatrist and other options should be considered if it is advisable. If further lithium use is deemed necessary, amiloride better ailments from diabetes insipidus. Lithium competes with Na at the luminal Na channels to enter the cells. Since the toxic effects of lithium in the headers are intracellular will blockade of luminal Na channels here lowering intracellular litoum and better sensitivity to ADH. Thiaziddiuretika and NSAIDs are also used in the treatment of renal diabetes insipidus. It is very important that lithium concentrations monitored when if one starts with amiloride, NSAIDs or thiazide diuretics when renal clearance of lithium may fall and the patient may develop severe lithium intoxication. Read more about lithium nephropathy
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