Skip to main content
Log in

Renal Function Related Changes in Lithium Kinetics

  • Review Article
  • Published:
Clinical Pharmacokinetics Aims and scope Submit manuscript

Abstract

The renal clearance of lithium will decrease, and hence the risk of acute lithium toxicity will increase, in any situation leading to dehydration and sodium depletion. Patients on long term lithium therapy with progressively declining urinary concentrating ability may be at special risk in this regard.

Chronic histological changes in the kidney attributed to lithium therapy correlate with age rather than with the duration of lithium therapy. Age-related renal histological changes are associated with decreased glomerular filtration rate and therefore reduced renal lithium clearance. Thus, the dose of lithium should be reduced with advancing age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Amdisen, A.: Monitoring of lithium treatment through determination of lithium concentration. Danish Medical Bulletin 22: 277–291 (1975).

    PubMed  CAS  Google Scholar 

  • Amdisen, A.: Serum level monitoring and clinical pharmacokinetics of lithium. Clinical Pharmacokinetics 2: 73–92 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Ashburner, J.V.: A case of chronic mania treated with lithium citrate and terminating fatally. Medical Journal of Australia 37: 386 (1950).

    Google Scholar 

  • Baer, L.; Classman, A.H. and Kassir, S.: Negative sodium balance in lithium carbonate toxicity. Evidence of mineralocorticoid blockade. Archives of General Psychiatry 29: 823–827 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Bohle, A.; Glomb, D.; Grund, K.E. and Mackensen, S.: Correlation between relative interstitial volume of the renal cortex and serum creatinine concentrations a minimal change with nephrotic syndrome and a focal sclerosing glomerulonephritis. Virchows Archiv (Pathol. Anat.) 376: 221–239 (1977).

    CAS  Google Scholar 

  • Burrows, G.D.; Davies, B. and Kincaid-Smith, P.: Unique tubular lesion after lithium. Lancet 2: 1310 (1978).

    Article  Google Scholar 

  • Cade, J.F.J.: Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia 36: 349–352 (1949).

    Google Scholar 

  • Coppen, A.; Noguera, R.; Bailey, J.; Burns, B.H.; Swani, M.S.; Hare, E.H.; Gardner, R. and Maggs, R.: Prophylactic lithium in affective disorders. Controlled trial. Lancet 2: 275–279 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Fyro, B.; Petterson, U. and Sedvall, G.: Pharmacokinetics of lithium in manic-depressive patients. Acta Psychiatrica Scandinavica 49: 237–247 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Hansen, H.E.: Renal toxicity of lithium. Drugs 22: 461–476 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Hansen, H.E. and Amdisen, A.: Lithium intoxication (report of 23 cases and review of 100 cases from the literature). Quarterly Journal of Medicine 47: 123–144 (1978).

    PubMed  CAS  Google Scholar 

  • Hansen, H.E.; Hestbech, J.; Olsen, S. and Amdisen, A.: Renal function and renal pathology in patients with lithium-induced impairment of renal concentrating ability; in Robinson (Ed.) Proceedings of the European Dialysis and Transplantation Association, Vol. 14, pp. 518–527 (Pitman Medical, London 1977).

    Google Scholar 

  • Hansen, H.E.; Hestbech, J.; Sorensen, J.L.; Norgaard, K.; Heilskov, J. and Amdisen, A.: Chronic interstitial nephropathy in patients on long-term lithium treatment. Quarterly Journal of Medicine 48: 577–591 (1979).

    PubMed  CAS  Google Scholar 

  • Hestbech, J.; Hansen, H.E.; Amdisen, A. and Olsen, S.: Chronic renal lesion following long-term treatment with lithium. Kidney International 12: 205–213 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Hullin, R.P.; McDonald, R. and Allsopp, M.N.E.: Prophylactic lithium in recurrent affective disorder. Lancet 1: 1044–1046 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Hullin, R.P.; Coley, V.P.; Birch, N.J.; Thomas, T.H. and Morgan, D.B.: Renal function after long-term treatment with lithium. British Medical Journal 1: 1457–1459 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, F.N. and Johnson, S.: Lithium in Medical Practice. (MTP Press, Lancaster 1978).

    Google Scholar 

  • Johnson, G.F.S.; Hunt, G.E.; Lewis, J. and St George, B.: Pharmacokinetics of standard (Lithicarb) and sustained-release (Priadel) lithium carbonate preparations in patients. Australian and New Zealand Journal of Psychiatry 16: 64–68 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Kincaid-Smith, P.; Burrows, G.D.; Davies, B.M.; Holwill, B.; Walter, M. and Walker, R.G.: Renal biopsy findings in lithium and pre-lithium patients. Lancet 2: 700–701 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Kincaid-Smith, P.; Walker, R.G.; Holwill, B.; Burrows, G.D. and Davies, B.M.: Renal biopsy studies of lithium, pre-lithium and donor kidneys; in Angrist et al. (Eds) Recent Advances in Neuropsychopharmacology (Advances in the Bio-Sciences) 31: 387–391 (Pergamon Press, Oxford and New York 1981).

    Google Scholar 

  • Lambinet, I.; Aymard, N.; Soulairac, A. and Reinberg, A.: Chronoptimization of lithium administration in five manic depressive patients: Reduction of nephrotoxicity. International Journal of Chronobiology 7: 274 (1981).

    Google Scholar 

  • Lehmann, K. and Merten, K.: Die elimination von Lithium in Abhangikeit vom Lebersalter bei Gesunden und Nierenin-suffizienten. International Journal of Clinical Pharmacology 10: 292–298 (1974).

    CAS  Google Scholar 

  • Mackensen, S.; Grund, K.E.; Sindjie, M. and Bohle, A.: Influence of the renal cortical interstitium on the serum creatinine concentration and serum creatinine clearance in different chronic sclerosing interstitial nephritides. Nephron 24: 30–34 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Mackensen-Haen, S.; Bader, R. and Bohle, A.: Correlation between renal cortical interstitial fibrosis, atrophy of the proximal tubules and impairment of glomerular filtration rate. Clinical Nephrology 15: 167–191 (1981).

    PubMed  CAS  Google Scholar 

  • Mason, R.W.; McQueen, E.G.; Keary, P.J. and James, N.McI: Pharmacokinetics of lithium: Elimination half-time, renal clearance and apparent volume of distribution in schizophrenia. Clinical Pharmacokinetics 3: 241–246 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Noack, C.H. and Trautner, E.M.: The lithium treatment of maniacal psychosis. Medical Journal of Australia 38: 219–222 (1951).

    Google Scholar 

  • Radomski, J.L.; Fuyat, H.N.; Nelson, A.A. and Smith, P.K.: The toxic effects, excretion and distribution of lithium chloride. Journal of Pharmacology and Experimental Therapeutics 100: 429–444 (1950).

    PubMed  CAS  Google Scholar 

  • Schou, M.: Lithium studies. I. Toxicity. Acta Pharmacologica et Toxicologica (Copenhagen) 15: 70–84 (1958a).

    Article  CAS  Google Scholar 

  • Schou, M.: Lithium Studies. II. Renal elimination. Acta Pharmacologica et Toxicologica (Copenhagen) 15: 85–98 (1958b).

    Article  CAS  Google Scholar 

  • Schou, M.; Juel-Nielsen, N.; Stromgren, E. and Voldby, H.: The treatment of manic psychoses by the administration of lithium salts. Journal of Neurology, Neurosurgery and Psychiatry 17: 250–260 (1954).

    Article  CAS  Google Scholar 

  • Steele, T.H.; Manuel, M.A.; Newton, M. and Boner, G.: Renal lithium absorption in man: Physiological and pharmacological determinants. American Journal of Medical Science 269: 249–363 (1975).

    Article  Google Scholar 

  • Thomsen, K.; Jensen, J. and Olesen, O.V.: Lithium-induced loss of body sodium and the development of severe intoxication in rats. Acta Pharmacologica et Toxicologica (Copenhagen) 35: 337–346 (1974).

    Article  CAS  Google Scholar 

  • Thomsen, K. and Schou, M.: Renal lithium excretion in man. American Journal of Physiology 215: 823–827 (1968).

    PubMed  CAS  Google Scholar 

  • Thomsen, K.; Schou, M.; Steiness, I. and Hansen, H.E.: Lithium as an indicator of proximal sodium reabsorption. Pflugers Archives 308: 180–184 (1969).

    Article  CAS  Google Scholar 

  • Tyrer, S.; Hullin, R.P.; Birch, N.J. and Goodwin, J.C.: Absorption of lithium following administration of slow-release and conventional preparations. Psychological Medicine 6: 51–58 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Walker, R.G.; Bennett, W.M.; Davies, B.M. and Kincaid-Smith, P.: Structural and functional effects of long term lithium therapy. Kidney International 21 (Suppl. II): 513–519 (1982b).

    Google Scholar 

  • Walker, R.G.; Davies, B.M.; Holwill, B.; Dowling, J.P. and Kincaid-Smith, P.: A clinico-pathological study of lithium nephrotoxicity. Journal of Chronic Diseases 35: 685–695 (1982a).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Norman, T.R., Walker, R.G. & Burrows, G.D. Renal Function Related Changes in Lithium Kinetics. Clin Pharmacokinet 9, 349–353 (1984). https://doi.org/10.2165/00003088-198409040-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003088-198409040-00004

Keywords

Navigation