Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
J Clin Psychopharmacol. 2011 Dec;31(6):769-73. doi: 10.1097/JCP.0b013e31823607db.
Lithium has been shown to increase serum creatinine levels in a subgroup of patients. However, lithium-induced increases in serum creatinine have not been well studied with regard to timing, trajectory, or predictability.
The medical records of 16 intellectually disabled individuals treated with lithium between 1980 and 2010 in whom serum creatinine levels peaked at 1.5 mg/100 mL or higher (ie, who developed renal insufficiency) were reviewed. These individuals were compared with a group of 36 similar lithium-treated individuals in whom serum creatinine did not reach 1.5 mg/100 mL.
The 16 lithium-treated individuals who developed renal insufficiency had a mean peak serum creatinine level of 1.8 ± 0.3 mg/100 mL while on lithium. The mean time from institution of lithium until the 1.5 mg/100 mL serum creatinine level was first reached was 7.9 years. After lithium was discontinued, overall mean serum creatinine levels did not significantly change. Reaching a serum creatinine level of 1.3 or 1.4 mg/100 mL predicted reaching a 1.5 mg/100 mL level or higher. No significant differences in the age lithium was started, baseline serum creatinine levels, years receiving lithium, sex, or race differentiated those who developed renal insufficiency.
Prescribing lithium led to elevated serum creatinine levels in some individuals. A serum creatinine level of 1.3 and/or 1.4 mg/100 mL predicted renal insufficiency. Clinical implications of this study are that if 1 serum creatinine result reaches 1.3 mg/100 mL or more, intensive monitoring for further increases is indicated.
锂已被证明会增加一部分患者的血清肌酐水平。然而，关于锂引起的血清肌酐升高的时间、轨迹或可预测性，尚未进行很好的研究。
回顾了 1980 年至 2010 年间接受锂治疗的 16 名智力障碍患者的病历，这些患者的血清肌酐水平达到或超过 1.5 mg/100 mL（即发生肾功能不全）。将这些患者与 36 名接受相似锂治疗但血清肌酐未达到 1.5 mg/100 mL 的患者进行比较。
16 名发生肾功能不全的锂治疗患者在接受锂治疗时的平均血清肌酐峰值为 1.8±0.3 mg/100 mL。从开始锂治疗到首次达到 1.5 mg/100 mL 血清肌酐水平的平均时间为 7.9 年。停用锂后，总体平均血清肌酐水平没有明显变化。达到血清肌酐水平 1.3 或 1.4 mg/100 mL 预示着会达到 1.5 mg/100 mL 或更高水平。开始使用锂的年龄、基线血清肌酐水平、接受锂治疗的年限、性别或种族均无显著差异。
锂的处方导致一些患者的血清肌酐水平升高。血清肌酐水平达到 1.3 和/或 1.4 mg/100 mL 预示着会发生肾功能不全。本研究的临床意义是，如果 1 次血清肌酐结果达到 1.3 mg/100 mL 或更高，应加强监测以进一步升高。
