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The effect of lithium on renal haemodynamic function

Published online by Cambridge University Press:  09 July 2009

S. P. Tyrer ,
R. G. Schacht ,
M. J. McCarthy ,
K. N. Menard ,
S. Leong  and
B. Shopsin
S. P. Tyrer*
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
R. G. Schacht
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
M. J. McCarthy
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
K. N. Menard
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
S. Leong
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
B. Shopsin
Affiliation:
Departments of Psychiatry and Pediatrics, New York University Medical Center, New York, USA
*
1 Address for correspondence: Dr S. P. Tyrer, Research Unit in Psychiatry, l-4 Claremont Terrace, University of Newcastle upon Tyne, Newcastle upon Tyne NEI 7RU.
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Synopsis

Renal concentrating capacity following 18 hours of fluid deprivation was measured in 75 patients receiving prophylactic lithium therapy, and in 30 affectively ill subjects receiving other drugs. The lithium-treated patients had significantly lower urine osmolality and higher serum osmolality than the control subjects. Older subjects, patients maintained at higher serum lithium levels and those with a history of previous neurotoxicity showed the most impairment. Ten patients with urine osmolalities of less than 700 mOsm/l following this test were investigated further. Inulin and para-amino hippurate (PAH) clearance rates were determined and the effect of a subpressor challenge of dopamine on these measures was observed. Half of the patients showed some reduction in inulin and PAH clearance, which was greatest in those patients who had been taking lithium for over 10 years. However, all of the patients tested showed the expected increase in renal blood flow and sodium and water excretion in response to dopamine. Six additional patients had clearance estimations made before starting lithium treatment which were repeated after a period of 3–6 months on the drug. No consistent changes in haemodynamics were observed.

Lithium clearly reduces renal concentrating capacity, but other measures of renal tubular function were well preserved in patients receiving long-term therapy. Glomerular function may be slightly reduced in patients taking lithium for long periods. The results show that prophylactic lithium treatment does not affect renal cortical function adversely in the majority of patients, but impaired renal concentrating ability is a common accompaniment.

Type
Research Article
Information
Psychological Medicine , Volume 13 , Issue 1 , February 1983 , pp. 61 - 69
Copyright
Copyright © Cambridge University Press 1983

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