Lithium is the mainstay treatment for patients with
bipolar disorder, but it generally causes
nephrogenic diabetes insipidus (NDI), a disorder in which the renal urine concentrating ability has become
vasopressin insensitive. Li-NDI is caused by
lithium uptake by collecting duct principal cells and downregulation of
aquaporin-2 (AQP2)
water channels, which are essential for water uptake from tubular urine. Recently, we found that the prophylactic administration of
acetazolamide to mice effectively attenuated Li-NDI. To evaluate whether
acetazolamide might benefit
lithium-treated patients, we administered
acetazolamide to mice with established Li-NDI and six patients with a
lithium-induced urinary concentrating defect. In mice,
acetazolamide partially reversed
lithium-induced
polyuria and increased urine osmolality, which, however, did not coincide with increased AQP2 abundances. In patients,
acetazolamide led to the withdrawal of two patients from the study due to side effects. In the four remaining patients
acetazolamide did not lead to clinically relevant changes in maximal urine osmolality. Urine output was also not affected, although none of these patients demonstrated overt
lithium-induced
polyuria. In three out of four patients,
acetazolamide treatment increased serum
creatinine levels, indicating a decreased glomerular filtration rate (GFR). Strikingly, these three patients also showed a decrease in systemic blood pressure. All together, our data reveal that
acetazolamide does not improve the urinary concentrating defect caused by
lithium, but it lowers the GFR, likely explaining the reduced urine output in our mice and in a recently reported patient with
lithium-induced
polyuria. The reduced GFR in patients prone to
chronic kidney disease development, however, warrants against application of
acetazolamide in Li-NDI patients without long-term (pre)clinical studies.