Nephrotoxizität und Langzeitbehandlung mit Lithium

Zusammenfassung

In der systematischen Übersichtsarbeit werden die verfügbaren Daten zu nephrotoxischen Effekten einer Langzeitbehandlung mit Lithium unter besonderer Berücksichtigung klinischer, pathophysiologischer und epidemiologischer Aspekte dargestellt. Lithium kann zu tubulärer Dysfunktion (nephrogener Diabetes insipidus, hyperchlorämische metabolische Azidose, vermehrte Natriurese) und lithiuminduzierter Nephropathie (LIN) mit eingeschränkter glomerulärer Filtrationsrate führen. Für das Vorgehen bei LIN unter laufender Lithiumbehandlung existieren gegenwärtig keine Leitlinien, sodass im Hinblick auf die Fortsetzung der Lithiumbehandlung jeweils eine individuelle Nutzen-Risiko-Bewertung erfolgen muss.

Abstract

With particular focus on clinical, pathophysiologic and epidemiologic aspects this systematic review article presents the available data on nephrotoxic effects of a long-term treatment with lithium. Lithium may lead to tubular dysfunction (LITD = nephrogenic diabetes insipidus, hyperchloremic metabolic acidosis, increased natriuresis) and lithium-induced nephropathy (LIN) with reduced glomerular filtration rate (GFR). The histopathologic finding of LIN is chronic tubulo-interstitial nephritis. LITD frequently presents with polydipsia/-uria and reduced urine osmolality, while LIN features a wide clinical spectrum ranging from clinically asymptomatic presentations with reduced GFR to end-stage renal failure. LIN seems to feature slow progression and is significantly less frequent than LITD. Regular monitoring of renal function is indispensable for patients treated with lithium. Patients with reduced GFR under treatment with lithium should always be presented to a nephrologist. Currently, there are no guidelines for the handling of patients with LIN and ongoing treatment with lithium. Thus, regarding continuation of lithium-treatment an individual benefit/risk assessment is necessary.

Schlüsselwörter

Amilorid - bipolare affektive Störung - nephrogener Diabetes insipidus - Niereninsuffizienz - tubuläre Dysfunktion

Keywords

amiloride - bipolar disorder - nephrogenic diabetes insipidus - renal insufficiency - tubular dysfunction

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