A Clinician’s Guide to Monitoring Kidney Function in Lithium-Treated Patients
J Clin Psychiatry 2010;71(9):1153-1157
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Bipolar disorder treatment guidelines recommend kidney-function monitoring at regular intervals for patients taking lithium, but they tend not to provide specifics with regard to what to measure and how to ensure that the results most accurately reflect true kidney function. This overview clarifies those practical aspects of monitoring that are often overlooked or misunderstood.
Data Sources: Utilized English language materials were obtained by PubMed searches (1970–2009), from the Lithium Information Center database, and from books. Search terms included lithium, kidney function, creatinine, creatinine clearance, GFR, GFR prediction equations, albuminuria, and urine concentration.
Data Synthesis: Urine osmolality most accurately reflects urine concentrating ability, although specific gravity is usually adequate for clinical purposes. Serum creatinine concentration can be influenced by extrarenal factors, but even when these are controlled, it remains a less than ideal measure of glomerular filtration rate (GFR). Prediction equations are used commonly to estimate GFR and are an advance over serum creatinine alone, but even they are not as useful when GFR is only mildly impaired. Urine albumin measurement is important, but it requires greater standardization and sensitivity to maximize its potential.
Conclusions: The safe and effective use of lithium requires regular monitoring of kidney function. Doing so effectively requires knowledge of what to measure, how to ensure accurate results, and how to properly interpret them.
J Clin Psychiatry 2010;71(9):1153–1157
Submitted: December 16, 2009; accepted March 24, 2010.(doi:10.4088/JCP.09m05917yel).
Corresponding author: James W. Jefferson, MD, Healthcare Technology Systems, Inc, 7617 Mineral Point Rd, Ste 300, Madison, WI 53717 (firstname.lastname@example.org).