Department of Psychiatry, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic.
J Clin Psychopharmacol. 2019 May/Jun;39(3):238-242. doi: 10.1097/JCP.0000000000001030.
Lithium in the form of lithium carbonate (Li2CO3) has become one of the most effective and widely prescribed drugs for mood stabilization. However, lithium has adverse effects on renal tubular functions, such as decreased concentrating function of the kidneys, and even occasional symptoms of nephrogenous diabetes insipidus occur with additional evidence of glomerular disruption in lithium-treated patients.
We assessed the kidney function of patients with bipolar disorder who are under long-term lithium treatment using novel markers of kidney damage such as plasma neutrophil gelatinase-associated lipocalin, cystatin C, albuminuria, estimated glomerular filtration rate, Chronic Kidney Disease-Epidemiology Investigation using creatinine and cystatin C, and serum and urinary osmolality, and compared the results with those of age-matched patients with bipolar disorder not treated with lithium. The study enrolled 120 patients with bipolar disorder, consisting of 80 (30 male and 50 female patients) who have been receiving lithium for 0.5 to 20 (mean, 7) years and 40 (10 male and 30 female patients) who had never been exposed to lithium treatment.
Patients treated with lithium had significantly decreased urine osmolality (mean ± SD, 405 ± 164 vs 667 ± 174 mmol/kg) and urine-to-serum osmolality ratio (1.35 ± 0.61 vs 2.25 ± 0.96). No significant difference was found in creatinine, estimated glomerular filtration rate values calculated using the Chronic Kidney Disease-Epidemiology Investigation using creatinine and cystatin C, neutrophil gelatinase-associated lipocalin, cystatin C, and albuminuria between both groups. We found no significant difference in renal biomarkers between patients treated with lithium for 6 to 24 months and those treated for 25 to 240 months.
We found significantly decreased kidney concentrating ability in the long-term lithium-treated patients compared with the control group. Other renal function markers did not indicate any significant signs of renal dysfunction.
碳酸锂（Li2CO3）形式的锂已成为最有效和广泛应用的稳定情绪药物之一。然而，锂对肾小管功能有不良影响，例如肾脏浓缩功能下降，甚至在锂治疗患者中还会出现偶尔的肾性尿崩症症状，并有肾小球破坏的额外证据。
我们使用新型肾损伤标志物评估长期接受锂治疗的双相情感障碍患者的肾功能，如血浆中性粒细胞明胶酶相关脂质运载蛋白、胱抑素 C、蛋白尿、估计肾小球滤过率、使用肌酐和胱抑素 C 的慢性肾脏病流行病学调查以及血清和尿液渗透压，并将结果与未接受锂治疗的年龄匹配的双相情感障碍患者进行比较。该研究纳入了 120 名双相情感障碍患者，其中 80 名（30 名男性和 50 名女性）接受锂治疗 0.5 至 20 年（平均 7 年），40 名（10 名男性和 30 名女性）从未接受过锂治疗。
锂治疗组患者的尿渗透压明显降低（均值 ± 标准差，405 ± 164 比 667 ± 174 mmol/kg）和尿与血清渗透压比值（1.35 ± 0.61 比 2.25 ± 0.96）。两组间肌酐、使用肌酐和胱抑素 C 的慢性肾脏病流行病学调查计算的估计肾小球滤过率值、中性粒细胞明胶酶相关脂质运载蛋白、胱抑素 C 和蛋白尿无显著差异。我们发现锂治疗 6 至 24 个月与治疗 25 至 240 个月的患者之间的肾生物标志物无显著差异。
与对照组相比，长期锂治疗患者的肾脏浓缩能力明显下降。其他肾功能标志物未显示任何明显的肾功能障碍迹象。
