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.
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).
Amdisen, A.: Serum level monitoring and clinical pharmacokinetics of lithium. Clinical Pharmacokinetics 2: 73–92 (1977).
Ashburner, J.V.: A case of chronic mania treated with lithium citrate and terminating fatally. Medical Journal of Australia 37: 386 (1950).
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).
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).
Burrows, G.D.; Davies, B. and Kincaid-Smith, P.: Unique tubular lesion after lithium. Lancet 2: 1310 (1978).
Cade, J.F.J.: Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia 36: 349–352 (1949).
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).
Fyro, B.; Petterson, U. and Sedvall, G.: Pharmacokinetics of lithium in manic-depressive patients. Acta Psychiatrica Scandinavica 49: 237–247 (1973).
Hansen, H.E.: Renal toxicity of lithium. Drugs 22: 461–476 (1981).
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).
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).
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).
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).
Hullin, R.P.; McDonald, R. and Allsopp, M.N.E.: Prophylactic lithium in recurrent affective disorder. Lancet 1: 1044–1046 (1972).
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).
Johnson, F.N. and Johnson, S.: Lithium in Medical Practice. (MTP Press, Lancaster 1978).
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).
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).
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).
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).
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).
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).
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).
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).
Noack, C.H. and Trautner, E.M.: The lithium treatment of maniacal psychosis. Medical Journal of Australia 38: 219–222 (1951).
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).
Schou, M.: Lithium studies. I. Toxicity. Acta Pharmacologica et Toxicologica (Copenhagen) 15: 70–84 (1958a).
Schou, M.: Lithium Studies. II. Renal elimination. Acta Pharmacologica et Toxicologica (Copenhagen) 15: 85–98 (1958b).
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).
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).
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).
Thomsen, K. and Schou, M.: Renal lithium excretion in man. American Journal of Physiology 215: 823–827 (1968).
Thomsen, K.; Schou, M.; Steiness, I. and Hansen, H.E.: Lithium as an indicator of proximal sodium reabsorption. Pflugers Archives 308: 180–184 (1969).
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).
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).
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).
Author information
Authors and Affiliations
Rights 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
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003088-198409040-00004