Reports of toxic effects on the kidney of
lithium treatment emerged very soon after
lithium therapy was introduced.
Lithium-induced
nephrogenic diabetes insipidus is usually self-limiting or not clinically dangerous. Some reports of irreversible
chronic kidney disease and
renal failure were difficult to attribute to
lithium treatment since
chronic kidney disease and
renal failure exist in the population at large. In recent years, large-scale epidemiological studies have convincingly shown that
lithium treatment elevates the risk of
chronic kidney disease and
renal failure. Most patients do not experience renal side effects. The most common side effect of
polyuria only weakly predicts increasing
creatinine or reduced kidney function. Among those patients who do experience decrease in
creatinine clearance, some may require continuation of
lithium treatment even as their
creatinine increases. Other patients may be able to switch to a different mood stabilizer medication, but kidney function may continue to deteriorate even after
lithium cessation. Most, but not all, evidence today recommends using a lower
lithium plasma level target for long-term maintenance and thereby reducing risks of severe nephrotoxicity.