Lithium and chronic kidney disease

Abstract

Lithium remains a key drug in the treatment of bipolar disorder1 and recurrent depressive disorder, and renal monitoring is essential for safe prescribing. The recent guidance from the National Institute for Health and Clinical Excellence (NICE) on early identification and management of chronic kidney disease mentions lithium as a nephrotoxin and emphasises active management of hypertension and other cardiovascular risk factors.2 Lithium prescribers in the United Kingdom already receive estimated glomerular filtration rate results when monitoring renal function in lithium users,3 and the inclusion of lithium monitoring in the primary care quality and outcomes framework has raised awareness about its importance. This article discusses the effects of lithium on the kidney and looks at existing evidence to guide treatment when incidental chronic kidney disease is detected in those in whom lithium is being considered or when long term lithium users develop chronic kidney disease.