title: Capillary electrophoresis mass spectrometry as a potential tool to detect lithium-induced nephropathy: Preliminary results.
abstract: Lithium remains the treatment of choice for many patients suffering from bipolar disorder. However, long-term treatment with lithium carries the potential to cause renal and thyroid dysfunction. Lithium-induced nephropathies are characterised by deterioration of urinary concentrating ability as well as, less frequently, a progressive and potentially irreversible decrease in glomerular filtration rate (GFR). Pathological changes after treatment with lithium include both tubulointerstitial and glomerular changes. Besides monitoring of the kidney-function, no screening-instruments exist for early identification of patients at risk of lithium-induced nephropathy. CE-MS (capillary electrophoresis coupled to a mass spectrometer) is a new technique that has been applied to the differential diagnosis of nephropathies. We sought to determine if CE-MS can be used to identify lithium-induced renal changes. A urine-sample was obtained from 14 subjects (7 males, 7 females, mean age 51.1 years) under long-term treatment with lithium (mean duration 17.4 years, range 8-35 years) without known nephropathy (mean creatinine 0.96 mg/dl; range 0.7-1.6). Urine samples were stored at -20 degrees C until analysis. CE-MS was performed according to standard procedures and a screen for nephropathies was used. Among the 14 urine samples, two subjects tested positive for a nephropathy. One further subject had a borderline result. Since 3/14 subjects with no known nephropathy showed some degree of pathological findings, CE-MS from a urine-sample may be helpful for the early detection of renal damage under treatment with lithium. However, a specific screen for lithium-induced nephropathies still needs to be developed.
authors.affiliation: University Medical Center Hamburg-Eppendorf, Dept. of Psychiatry, Martinistr. 52, 20246 Hamburg, Germany. thomas.raedler@calgaryhealthregion.ca
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Raedler
authors.forename: Stefan
authors.initials: S
authors.lastname: Wittke
authors.forename: Holger
authors.initials: H
authors.lastname: Jahn
authors.forename: Andreas
authors.initials: A
authors.lastname: Koessler
authors.forename: Harald
authors.initials: H
authors.lastname: Mischak
authors.forename: Klaus
authors.initials: K
authors.lastname: Wiedemann
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019075:Electrophoresis, Capillary / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008094:Lithium; D008297:Male; D013058:Mass Spectrometry / Q000379:methods*; D009393:Nephritis / Q000139:chemically induced* / Q000145:classification / Q000652:urine; D013997:Time Factors
chemical_list: D008094:Lithium