Table 2 Prevention and management of kidney injury during lithium treatment
From: Effectiveness of ultra-long-term lithium treatment: relevant factors and case series
Prevention | Management |
|---|---|
Baseline assessment of renal function Using lithium in lowest effective dose In the first five years, lithium administration in one daily dose Avoiding high lithium levels and lithium intoxication Monitoring polyuria, in severe cases adding amiloride or hydrochlorothiazide | Monitoring of creatinine and GFR In case of GFR below 60 min/min or decline 5 ml/min/year or 10 ml/min/5 year: Monitoring 2–4 times/year Consider reducing lithium dose Referring to a nephrologist—explore other possible etiologies of renal insufficiency Lithium discontinuation and replacing with other mood stabilizer—very gradually should be a decision of last resort |