title: The effects of lithium on renal function in older adults--a systematic review.
abstract: Chronic renal failure (CRF) and nephrogenic diabetes insipidus (NDI) are potential consequences of chronic lithium use, while acute renal failure (ARF) has been described in lithium intoxication. We performed a systematic review of all studies pertaining to the effects of lithium on the kidney in older adults. The ARF incidence was 1.5% per person-year and concurrent loop diuretic and angiotensin-converting enzyme inhibitor use with lithium increased the risk. The CRF prevalence estimates varied from 1.2% to 34%, with risk factors including age, previous lithium intoxication, polyuria, previously impaired renal function, and decreased maximal urine osmolality. The prevalence of NDI varied widely from 1.8%  to 85%. Risk factors included lithium duration, dose, level, slow-release formulation, and clinical nonresponse. Except for amiloride use in NDI, there is little evidence for treatment of other lithium-induced adverse renal effects. Currently, there is no compelling evidence to suggest that lithium should be avoided in elderly patients for fear of renal side effects.
authors.affiliation: Psychiatry Resident, McGill University, Montreal, QC, Canada.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000367:Age Factors; D000368:Aged; D004305:Dose-Response Relationship, Drug; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000628:therapy; D018020:Lithium Compounds / Q000009:adverse effects*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D018020:Lithium Compounds