Lithium-Induced Nephropathy in Bipolar Disorder: A Clinical Concern

Results

The prevalence of renal dysfunction among patients on long-term lithium therapy is approximately 25%, with women under 60 showing the highest risk (57-63%). Between 15-25% of patients may experience a gradual decline in Glomerular Filtration Rate (GFR), potentially leading to end-stage renal disease (ERD) after decades of exposure. Risk factors include treatment duration, cumulative dose, episodes of acute intoxication, advanced age, comorbidities, and concomitant use of antipsychotics or diuretics. The clinical presentation is typically insidious, with polyuria, proteinuria, nephrogenic diabetes insipidus and progressive decline in GFR. Histological findings include microcyst formation in both cortex and medulla, interstitial fibrosis, and focal segmental glomerulosclerosis in severe cases. Pathophysiology involves lithium entry through renal sodium channels, causing tubular injury and impaired water regulation. Stopping lithium may stabilize or slow disease progression, particularly in early stages, but full reversibility is rare. Recovery is more likely when baseline GFR exceeds 30mL/min, with stabilization usually occurring within 12-24 months after discontinuation. No specific treatment exists beyond lithium withdrawal and management of complications, although amiloride may reduce polyuria, without robust evidence for preventing chronic nephropathy. Prognosis is influenced by baseline renal function, proteinuria burden, comorbidities, and histological severity.