Jagsch Christian, Wirnsberger Gerhard, Simhandl Christian
Abteilung für Alterspsychiatrie und Alterspsychotherapie, LKH-Graz II, 8053, Graz, Österreich.
Abteilung für Interne Medizin, Nephrologie, Medizinische Universität Graz, 8010, Graz, Österreich.
Neuropsychiatr. 2025 Jun 27. doi: 10.1007/s40211-025-00532-8.
Despite its substantial therapeutic efficacy-particularly in the acute treatment and relapse prevention of bipolar affective disorders-lithium is associated with a broad spectrum of side effects, among which potential nephrotoxicity represents one of the most significant long-term risks. In clinical practice, particularly in the treatment of older adults, physicians are often faced with the question of whether lithium therapy can or should be continued, or whether initiation is feasible, given comorbid somatic illnesses, polypharmacy, or reduced glomerular filtration rate (GFR). The aim of this review is to provide practical, evidence-based recommendations for clinical decision-making.
A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar, focusing on the treatment of patients with bipolar and unipolar affective disorders with lithium and its potential effects on renal function, particularly in the context of long-term therapy and aging. A case report is included to illustrate clinical application.
Lithium remains a cornerstone in the pharmacological treatment of bipolar and unipolar affective disorders, despite its known nephrotoxic potential. Optimizing the balance between therapeutic benefit and potential renal risks necessitates close monitoring and individualized treatment adjustments. The risk of lithium-induced nephropathy increases with the duration of therapy, patient age, and the frequency of episodes of lithium toxicity or overdose. Current guidelines recommend maintaining serum lithium levels within a range of 0,6-0,8 mmol/L. In older patients with good treatment response, target levels at the lower end of the therapeutic window (0,4-0,6 mmol/L) are advised. Lithium therapy should be monitored at regular intervals, including laboratory testing and 12-hour serum level checks every three months, or every 8-10 weeks in elderly patients. If GFR falls below 30 ml/min/1,73 m, nephrology consultation is warranted, and the continuation of lithium treatment should be critically re-evaluated. In patients with a GFR below 45 ml/min/1,73 m, initiation of lithium therapy in old age is not recommended. Decisions regarding the discontinuation or initiation of lithium therapy should always be made on an individual and interdisciplinary basis, carefully weighing the therapeutic benefit against the risk of affective relapse and the potential for progressive renal impairment.
尽管锂盐具有显著的治疗效果，尤其是在双相情感障碍的急性治疗和预防复发方面，但它会引发一系列副作用，其中潜在的肾毒性是最重大的长期风险之一。在临床实践中，特别是在老年患者的治疗中，考虑到合并的躯体疾病、联合用药或肾小球滤过率（GFR）降低，医生常常面临锂盐治疗是否能够或应该继续，或者起始治疗是否可行的问题。本综述的目的是为临床决策提供实用的、基于证据的建议。
使用PubMed、科学网和谷歌学术进行全面的文献检索，重点关注锂盐治疗双相和单相情感障碍患者及其对肾功能的潜在影响，特别是在长期治疗和老龄化背景下。纳入一份病例报告以说明临床应用。
尽管锂盐存在已知的肾毒性潜力，但它仍然是双相和单相情感障碍药物治疗的基石。优化治疗益处与潜在肾脏风险之间的平衡需要密切监测和个体化的治疗调整。锂盐诱导的肾病风险随治疗持续时间、患者年龄以及锂盐毒性或过量发作频率的增加而升高。当前指南建议将血清锂水平维持在0.6 - 0.8 mmol/L范围内。对于治疗反应良好的老年患者，建议将目标水平设定在治疗窗口的较低端（0.4 - 0.6 mmol/L）。应定期监测锂盐治疗，包括实验室检查以及每三个月进行一次12小时血清水平检查，老年患者每8 - 10周检查一次。如果GFR降至30 ml/min/1.73 m²以下，有必要咨询肾脏科医生，并应严格重新评估锂盐治疗的继续与否。对于GFR低于45 ml/min/1.73 m²的患者，不建议在老年时起始锂盐治疗。关于停用或起始锂盐治疗的决策应始终基于个体和跨学科的基础，仔细权衡治疗益处与情感复发风险以及进行性肾功能损害的可能性。
