Vestergaard P, Amdisen A, Hansen H E, Schou M
Acta Psychiatr Scand. 1979 Nov;60(5):504-20. doi: 10.1111/j.1600-0447.1979.tb00559.x.
Kidney function has been examined in 237 patients who in the autumn of 1977 were in lithium treatment at the Psychiatric Hospital in Risskov, most of them as outpatients. The average age was 42 years. The patients had been given lithium treatment for 0.5-17 years, mean duration 5 years. The mean lithium dosage was 33 mmol/day and the mean 12-hour serum lithium concentration 0.85 mmol/l. Glomerular filtration rate was assessed through determination of 24-hour creatinine clearance and serum creatinine, in some cases iothalamate clearance. Water excretion was assessed through determination of 24-hour urine volume and in some cases urine osmolality after 26 hours of fluid deprivation. Creatinine clearances, serum creatinine concentrations, and urine volumes were subjected to multiple regression analysis with various clinically relevant predictor variables. Affection of glomerular filtration rate was only moderate and progressed slowly. The data indicate that the risk of renal insufficiency and terminal azotemia is remote even when lithium is given for many years. A large number of the patients had altered water excretion with polyuria or lowered urine concentrating ability or both. Due to the extra fluid loss these patients are apt to develop dehydration, and they may then be in danger of lithium poisoning. We hypothesize that lithium-induced changes of kidney function may become less frequent and less pronounced if patients are maintained at serum lithium levels somewhat lower than those employed in the group studied here. We recommend careful monitoring of serum lithium levels, regular control of kidney function, and extra caution when physical illness or additional drug treatment may lead to disturbance of fluid and electrolyte balance.
对237名患者的肾功能进行了检查，这些患者于1977年秋季在里斯科夫精神病院接受锂治疗，其中大多数为门诊患者。平均年龄为42岁。患者接受锂治疗的时间为0.5至17年，平均疗程为5年。平均锂剂量为33 mmol/天，平均12小时血清锂浓度为0.85 mmol/L。通过测定24小时肌酐清除率和血清肌酐来评估肾小球滤过率，在某些情况下测定碘他拉酸盐清除率。通过测定24小时尿量并在某些情况下在禁水26小时后测定尿渗透压来评估水排泄。对肌酐清除率、血清肌酐浓度和尿量进行多元回归分析，并纳入各种临床相关的预测变量。肾小球滤过率的影响仅为中度且进展缓慢。数据表明，即使长期服用锂，发生肾功能不全和终末期氮质血症的风险也很小。大量患者出现水排泄改变，表现为多尿或尿浓缩能力降低或两者兼有。由于额外的液体流失，这些患者容易发生脱水，进而可能有锂中毒的危险。我们推测，如果将患者的血清锂水平维持在略低于本研究组所采用的水平，锂诱导的肾功能变化可能会变得不那么频繁和明显。我们建议密切监测血清锂水平，定期检查肾功能，并且当身体疾病或额外的药物治疗可能导致体液和电解质平衡紊乱时要格外小心。
