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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by undopaminergic on February 1, 2023, at 14:16:04
Hi all,
For anyone interested in the question of the effects of lithium on kidney function (and structure), here is a review article which offers a discussion of the topic, as well as clinical guidelines as to when to terminate lithium therapy for nephrological reasons.
"Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification"
https://pubmed.ncbi.nlm.nih.gov/30390660/
Full article:
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-018-1101-4Note that the article does not attempt to elucidate the mechanisms though which lithium may cause harm to the kidneys.
-undopaminergic
Posted by SLS on February 1, 2023, at 17:48:59
In reply to Lithium and kidney function review, posted by undopaminergic on February 1, 2023, at 14:16:04
> Hi all,
>
> For anyone interested in the question of the effects of lithium on kidney function (and structure), here is a review article which offers a discussion of the topic, as well as clinical guidelines as to when to terminate lithium therapy for nephrological reasons.
>
> "Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification"
> https://pubmed.ncbi.nlm.nih.gov/30390660/
> Full article:
> https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-018-1101-4
>
> Note that the article does not attempt to elucidate the mechanisms though which lithium may cause harm to the kidneys.
>
> -undopaminergic
I don't think the article emphasizes enough that kindney damage is dosage dependent. I've been taking lithium 300 mg/day for over 10 years. Regular blood tests have never shown any abnormal results. My thyroid has been normal all of this time. As the article states, the longer one takes lithium for, the higher the risk of developing nephrotoxity - but this applies to *normal* (high-dosage) therapeutic dosages of 900-1500 mg/day. At low dosages (150-450 mg/day), the length of treatment is no longer a risk factor.Another thing that I haven't seen mentioned here is that taking the entire daily dosage as a single dose at night reduces the risk of nephrotoxicity.
In 2023, I think lithium is under-utilized.
- Scott
Posted by PeterMartin on February 7, 2023, at 14:27:58
In reply to Re: Lithium and kidney function review » undopaminergic, posted by SLS on February 1, 2023, at 17:48:59
There is a recent study that found Metformin can prevent/attenuate Lithium induced kidney damage (at least in rodents). Metformin does tons of amazing things for the body.
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https://pubmed.ncbi.nlm.nih.gov/34595852/
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2021 Nov;30Protective effect of metformin on lithium-induced nephrogenic diabetes insipidus: An experimental study in rats
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Abstract
Background: Lithium is widely used in the treatment of bipolar disorders and may lead to nephrogenic diabetes insipidus (NDI), following long-term treatment. Metformin is considered the preferred initial therapy for patients with type 2 diabetes mellitus (T2D).Objectives: To investigate the protective effect of metformin on the kidney damage caused by lithium administration.
Material and methods: Using an animal model of chronic lithium-induced NDI, rats were divided into 4 groups: sham, metformin, lithium, and lithium + metformin. The effects of these treatments were examined using serum electrolytes, blood and tissue total antioxidant status, total oxidant status, the oxidative stress index, urine and blood osmolality, and tissue aquaporin-2 (AQP2) levels. Additionally, histopathological changes, including congestion, hydropic swelling, tubular necrosis, tubular atrophy, and Bowman's capsule dilatation, were evaluated. The total histopathological score was obtained by summing the scores for each pathological finding.
Results: In the lithium group, biochemical variables indicating NDI, including sodium, chloride and blood osmolality, increased, and urine osmolality decreased, compared to the sham group. With metformin treatment, the blood osmolality decreased from 328.17 mOsm/kg to 306.33 mOsm/kg, and urine osmolality increased from 349.67 mOsm/kg to 754.50 mOsm/kg (p = 0.004 and p = 0.001, respectively). Tissue AQP2 levels decreased with lithium administration but stabilized with metformin treatment. Additionally, in comparison to the lithium group, the total histopathological score in the metformin group declined from 8.0 to 2.0 (p = 0.002).
Conclusions: Metformin may help protect the kidneys from lithium-induced NDI through the AQP2 regulating effect and a reduction in oxidative stress.
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