Hullin R P, Coley V P, Birch N J, Thomas T H, Morgan D B
Br Med J. 1979 Jun 2;1(6176):1457-9. doi: 10.1136/bmj.1.6176.1457.
Daily urine volumes, plasma creatinine concentrations, and creatinine clearance were measured in 106 patients with unipolar and bipolar affective disorders attending a "lithium" clinic. Urine volumes exceeded 3.51 in only six patients, plasma creatinine concentrations exceeded 150 mumol/1 (1.7 mg/100 ml) in only five, and creatinine clearance was below 50 ml/min in 16. Renal function was assessed by measuring creatinine clearance and renal tubular function, including response to 20 hours of water deprivation, in a representative sample of 30 patients from the lithium clinic and 30 psychiatric patients matched for age and sex who were taking other psychotropic drugs. Creatinine clearance and tubular function, including urine osmolality after water deprivation, were not significantly different between the two groups. Urinary excretion of arginine vasopressin (AVP), however, was much greater in the lithium-treated patients, who therefore had a diminished tubular responsiveness to AVP. The findings do not support suggestions that long-term lithium treatment results in seriously impaired renal function, renal damage, and polyuria. Compared with other series, however, the patients were being maintained with low serum lithium concentrations, which apparently area as effective prophylactically as higher concentrations.
对在一家“锂盐”门诊就诊的106例单相和双相情感障碍患者测量了每日尿量、血浆肌酐浓度和肌酐清除率。仅6例患者尿量超过3.5升，仅5例血浆肌酐浓度超过150μmol/L（1.7mg/100ml），16例肌酐清除率低于50ml/分钟。在来自锂盐门诊的30例代表性患者以及30例年龄和性别匹配、正在服用其他精神药物的精神病患者中，通过测量肌酐清除率和肾小管功能（包括对20小时禁水的反应）来评估肾功能。两组之间的肌酐清除率和肾小管功能（包括禁水后的尿渗透压）没有显著差异。然而，接受锂盐治疗的患者精氨酸加压素（AVP）的尿排泄量要高得多，因此他们的肾小管对AVP的反应性降低。这些发现不支持长期锂盐治疗会导致严重肾功能损害、肾损伤和多尿的观点。然而，与其他系列研究相比，这些患者维持的血清锂浓度较低，而这显然与较高浓度一样具有有效的预防作用。
