Nephrotoxizität und Langzeitbehandlung mit Lithium

Maximilian Gahr; Roland W. Freudenmann; Bernhard J. Connemann; Frieder Keller; Carlos Schönfeldt-Lecuona

doi:10.1055/s-0033-1349490

Psychiatrische Praxis, Inhaltsverzeichnis

Psychiatr Prax 2014; 41(01): 15-22
DOI: 10.1055/s-0033-1349490

Übersicht

Nephrotoxizität und Langzeitbehandlung mit Lithium

Nephrotoxicity and Long-Term Treatment with Lithium

Maximilian Gahr

¹Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm

,

Roland W. Freudenmann

¹Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm

,

Bernhard J. Connemann

¹Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm

,

Frieder Keller

²Abteilung Innere Medizin I, Sektion Nephrologie, Universitätsklinikum Ulm

,

Carlos Schönfeldt-Lecuona

¹Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm

› Institutsangaben

Abstract

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

Volltext

Referenzen

Literatur
1 Johnson F. The history of lithium therapy. London: Macmillan; 1984
2 Garrod A. The nature and treatment of gout and rheumatic gout. London: Walton; 1859
3 Parker G. John Cade. Am J Psychiatry 2012; 169: 125-126
4 Mitchell S. On the use of bromide of lithium. Am J Med Sci 1877; 60: 443-445
5 Mitchell S. Clinical lecture on nervousness in the male. Med News 1877; 35: 177-184
6 Hammond W. A treatise on diseases of the nervous system. New York: Appleton; 1871
7 Schioldann J. The Lange theory of “periodical depressions”. Adelaide: Adelaide Academic Press; 2001
8 Schou M, Juel-Nielsen N, Strömgren E et al. The treatment of manic psychoses by the administration of lithium salts. J Neurol Neurosurg Psychiatr 1954; 17: 250-260
9 Cipriani A, Barbui C, Salanti G et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011; 378: 1306-1315
10 Geddes J, Burgess S, Hawton K et al. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004; 161: 217-222
11 Burgess S, Geddes J, Hawton K et al. Lithium for maintenance treatment of mood disorders. Cochrane Database Syst Rev 2001; CD003013
12 Cipriani A, Smith K, Burgess S et al. Lithium versus antidepressants in the long-term treatment of uniplar affective disorder. Cochrane Database Syst Rev 2006; CD003492
13 Bauer M, Adli M, Baethge C et al. Lithium augementation therapy in refractory depression: clinical evidence and neurobiological mechanisms. Can J Psychiatry 2003; 48: 440-448
14 Tondo L, Hennen J, Baldessarini R. Lower suicide risk with long-term lithium treatment in major affective illness: a meta-analysis. Acta Psychiatr Scand 2001; 104: 163-172
15 Cipriani A, Pretty H, Hawton K et al. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005; 162: 1805-1819
16 Müller-Oerlinghausen B, Felber W, Berghöfer A et al. The impact of lithium long-term medication on suicidal behavior and mortality of bipolar patients. Arch Suicide Res 2005; 9: 307-319
17 DGBS, DGPPN. S3-Leitlinie zur Diagnostik und Therapie Bipolarer Störungen. 2012. Langversion (Mai). Im Internet: http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/kurzversion-leitlinien/s3-leitlinie-bipolar.pdf (Stand: 30.07.2013)
18 Rote Liste 2011 – Arzneimittelverzeichnis für Deutschland (einschließlich EU-Zulassungen und bestimmter Medizinprodukte). Frankfurt/Main: Rote Liste Service GmbH; 2011
19 Lombardi G, Panza N, Biondi D et al. Effects of lithium treatment on hypothalamic-pituitary-thyroid axis: a longitudinal study. J Endocrinol Invest 1993; 16: 259-263
20 Kusalic M, Engelsmann F. Effect of lithium maintenance therapy on thyroid and parathyroid function. J Psychiatry Neurosci 1999; 24: 227-233
21 Malhi G, Tanious M, Das P et al. The science and practice of lithium therapy. Aust N Z J Psychiatry 2012; 46: 192-211
22 Bowden C, Calabrese J, Ketter T et al. Impact of lamotrigine and lithium on weight in obese an nonobese patients with bipolar I disorder. Am J Psychiatry 2006; 163: 1199-1201
23 Sachs G, Bowden C, Calabrese J et al. Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder. Bipolar Disord 2006; 8: 175-181
24 Keck P, McElroy S. Bipolar disorder, obesity, and pharmacotherapy-associated weight gain. J Clin Psychiatry 2003; 64: 1426-1435
25 Timmer R, Sands J. Lithium intoxication. J Am Soc Nephrol 1999; 10: 666-674
26 Hsu C, Liu P, Chen J et al. Electrocardiographic abnormalities as predictors for over-range lithium levels. Cardiology 2005; 103: 101-106
27 Roose S, Nurnberger J, Dunner D et al. Cardiac sinus node dysfunction during lithium treatment. Am J Psychiatry 1979; 136: 804-806
28 Chang Y, Lin H, Deng H. Subclinical lithium neurotoxicity: correlation of neural conduction abnormalities and serum lithium level in manic-depressive patients with lithium treatment. Acta Neurol Scand 1990; 82: 82-86
29 Adityanjee MBBS, Munshi K, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28: 38-49
30 Fountoulakis K, Vieta E, Bouras C et al. A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?. Int J Neuropsychopharmacol 2008; 11: 269-287
31 Lydiard R, Gelenberg A. Hazards and adverse effects of lithium. Ann Rev Med 1982; 33: 327-344
32 Kropf D, Müller-Oerlinghausen B. Changes in learning, memory, and mood during lithium treatment. Approach to a research strategy. Acta Psychiatr Scand 1979; 59: 97-124
33 Grandjean E, Aubry J. Lithium: updated human knowledge using an evidence-based approach: Part II: clinical pharmacology and therapeutic monitoring. CNS Drugs 2009; 23: 331-349
34 Wingo A, Wingo T, Harvey P et al. Effects of lithium on cognitive performance: a meta-analysis. J Clin Psychiatry 2009; 70: 1588-1597
35 Grünfeld J, Rossier B. Lithium nephrotoxicity revisited. Nat Rev Nephrol 2009; 5: 270-276
36 Finley P, Warner M, Peabody C. Clinical relevance of drug interactions with lithium. Clin Pharmacokinet 1995; 29: 172-191
37 Llewellyn A, Stowe Z, Strader JJ. The use of lithium and management of woman with bipolar disorder during pregnancy and lactation. J Clin Psychiatry 1998; 53 (Suppl. 06) 57-65
38 Eastham J, Jeste D, Young R. Assessment and treatment of bipolar disorder in the elderly. Drugs Aging 1998; 12: 205-224
39 Rej S, Herrmann N, Shulman K. The effects of lithium on renal function in older adults – a systematic review. J Ger Psychiatry 2012; 25: 51-61
40 Fyro B, Pettersson U, Sedvall G. Serum lithium levels and side effects during administration of lithium carbonate and two slow release lithium preparations to human volunteers. Pharmacologia Clinica 1970; 2: 236-240
41 Gitlin M. Lithium and the kidney – an updated review. Drug Safety 1999; 20: 231-243
42 Sproule B, Hardy B, Shulman K. Differential pharmakokinetics of lithium in elderly patients. Drugs Aging 2000; 16: 165-177
43 Eyer F, Pfab R, Felgenhauer N et al. Lithium poisoning: pharmacokinetics and clearance during different therapeutic measures. J Clin Psychoparmacol 2006; 26: 325-330
44 Hundley J, Woodrum D, Saunders B et al. Revisiting lithium-associated hyperparathyroidism in the era of intraoperative parathyroid hormone monitoring. Surgery 2005; 138: 1027-1031
45 Bedford J, Weggery S, Ellis G et al. Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride. Clin J Am Soc Nephrol 2008; 3: 1324-1331
46 Bendz H, Aurell M. Drug-induced diabetes insipidus: incidence, prevention and management. Drug Safety 1999; 21: 449-456
47 Walker R, Weggery S, Bedford J et al. Lithium-induced reduction in urinary concentrating ability and urinary aquaporin 2 (AQP2) excretion in healthy volunteers. Kidney Int 2005; 67: 291-294
48 Marples D, Christensen S, Christensen E et al. Lithium-induced downregulation of aquaporin-2 water channel expression in rat kidney medulla. J Clin Invest 1995; 95: 1838-1845
49 Laursen U, Pihakaski-Maunsbach K, Kwon T et al. Changes of rat kidney AQP2 and Na,K-ATPase mRNA expression in lithium-induced nephrogenic diabetes insipidus. Nephron Exp Nephrol 2004; 97: e1-16
50 Kim Y, Kwon T, Christensen B et al. Altered expression of renal acid-base transporters in rats with lithium-induced NDI. Am J Physiol Renal Physiol 2003; 285: F1244-1257
51 Christensen B, Marples D, Kim Y et al. Changes in cellular composition of kidney collecting duct cells in rats with lithium-induced NDI. Am J Physiol Cell Physiol 2004; 286: C952-964
52 Nielsen J, Kwon T, Praetorius J et al. Segment-specific ENaC downregulation in kidney of rats with lithium-induced NDI. Am J Physiol Renal Physiol 2003; 285: F1198-1209
53 Nielsen J, Kwon T, Frøkiaer J et al. Lithium-induced NDI in rats is associated with loss of alpha-ENaC regulation by aldosterone in CCD. Am J Physiol Renal Physiol 2006; 290: F1222-1233
54 Christensen B, Loffing J, Hummler E et al. Collecting duct-specific gene inactivation of α ENaC protects mice against lithium-induced nephrogenic diabetes insipidus. J Am Soc Nephrol 2006; 17: 295A
55 Galizia L, Marino G, Kotsias B. Lithium and its relation with the epithelial sodium channel and aquaporin-2. Medicine (B Aires) 2012; 72: 171-175
56 Rojek A, Nielsen J, Brooks H et al. Altered expression of selected genes in kidney of rats with lithium-induced NDI. Am J Physiol Renal Physiol 2005; 288: F1276-1289
57 Rao R, Zhang M, Zhao M et al. Lithium treatment inhibits renal GSK-3 activity and promotes cyclooxygenase 2-dependent polyuria. Am J Physiol Renal Physiol 2005; 288: F642-649
58 Kotnik P, Nielsen J, Kwon T et al. Altered expression of COX-1, COX-2, and mPGES in rats with nephrogenic and central diabetes insipidus. Am J Physiol Renal Physiol 2005; 288: F1053-1068
59 Li Y, Shaw S, Kamsteeg E et al. Development of lithium-induced nephrogenic diabetes insipidus is dissociated from adenylyl cyclase activity. J Am Soc Nephrol 2006; 17: 1063-1072
60 Bedford J, Leader J, Jing R et al. Amiloride restores renal medullary osmolytes in lithium-induced nephrogenic diabetes insipidus. Am J Physiol Renal Physiol 2008; 294: F812-820
61 Batlle D, von Riotte A, Gaviria M et al. Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. N Engl J Med 1985; 312: 408-414
62 Hestbech J, Hansen H, Amdisen A et al. Chronic renal lesions following long-term treatment with lithium. Kidney Int 1977; 12: 205-213
63 Markowitz G, Radhakrishnan J, Kambham N et al. Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy. J Am Soc Nephrol 2000; 11: 1439-1448
64 Presne C, Fakhouri F, Noël L et al. Lithium-induced nephropathy: Rate of progression and prognostic factors. Kidney Int 2003; 64: 585-592
65 Farres M, Ronco P, Saadoun D et al. Chronic lithium nephropathy: MR imaging for diagnosis. Radiology 2003; 229: 570-574
66 Santella R, Rimmer J, MacPherson B. Focal segmental glomerulosclerosis in patients receiving lithium carbonate. Am J Med Sci 1988; 84: 951-954
67 Johnson G. Lithium – early development, toxicity, and renal function. Neuropsychopharmacology 1998; 19: 200-205
68 Freeman M, Freeman S. Lithium: clinical considerations in internal medicine. Am J Med Sci 2006; 119: 478-481
69 Bendz H, Sjödin I, Aurell M. Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium-withdrawal study. Nephrol Dial Transplant 1996; 11: 457-460
70 Muir A, Davidson R, Silverstone T et al. Two regimens of lithium prophylaxis and renal function. Acta Psychiatr Scand 1989; 80: 579-583
71 Quiroz J, Gould T, Manji H. Molecular effects of lithium. Mol Interv 2004; 4: 259-272
72 Boton R, Gaviria M, Battle D. Prevalance, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. Am J Kidney Dis 1987; 10: 329-345
73 Stone K. Lithium-induced nephrogenic diabetes insipidus. J Am Board Fam Prac 1999; 12: 43-47
74 Giles P, Fitzmaurice D. Formula estimation of glomerular filtration rate: have we gone wrong?. BMJ 2007; 334: 1198-1200
75 Stevens L, Zhang Y, Schmid C. Evaluating the performance of equations for estimating glomerular filtration rate. J Nephrol 2008; 21: 797-807
76 Bassilios N, Martel P, Godard V et al. Monitoring of glomerular filtration rate in lithium-treated outpatients – an ambulatory laboratory database surveillance. Nephrol Dial Transplant 2008; 23: 562-565
77 Lokkegaard H, Andersen N, Henriksen E et al. Renal function in 153 manic-depressive patients treated with lithium for more than five years. Acta Psychiatr Scand 1985; 71: 347-355
78 Waller D, Edwards J, Papasthatis-Papayanni S. A longitudinal assessment of renal function during treatment with lithium. Q J Med 1988; 68: 553-558
79 Schou M, Vestergaard P. Prospective studies on a lithium cohort. 2. Renal function. Water and electrolyte metabolism. Acta Psychiatr Scand 1988; 78: 427-433
80 Povlsen U, Hetmar O, Ladefoged J et al. Kidney functioning during lithium treatment: a prospective study of patients treated with lithium for up to ten years. Acta Psychiatr Scand 1992; 85: 56-60
81 DePaulo JJ, Correa E, Sapir D. Renal function and lithium: a longitudinal study. Am J Psychiatry 1986; 143: 892-895
82 Smigan L, Bucht G, von Knorring L et al. Long-term lithium treatment and renal functions. A prospective study. Neuropsychobiology 1984; 11: 33-38
83 Kallner G, Petterson U. Renal, thyroid and parathyroid functioning during lithium treatment: laboratory tests in 207 people treated for 1-30 years. Acta Psychiatr Scand 1995; 91: 48-51
84 Tredget J, Kirov A, Kirov G. Effects of chronic lithium treatment on renal function. J Affect Disord 2010; 126: 436-440
85 Janowsky D, Soares J, Hatch J et al. Lithium effect on renal glomerular function in individuals with intellectual disability. J Clin Psychopharmacol 2009; 29: 296-299
86 Bendz H, Schön S, Attman P et al. Renal failure occurs in chronic lithium treatment but is uncommon. Kidney Int 2010; 77: 219-224
87 Bendz H, Aurell M, Balldin J et al. Kidney damage in long-term lithium patients: a cross-sectional study of patients with 15 years or more on lithium. Nephrol Dial Transplant 1994; 9: 1250-1254
88 Bendz H, Andersch S, Aurell M. Kidney function in an unselected lithium population. A cross-sectional study. Acta Psychiatr Scand 1983; 68: 325-334
89 Janowsky D, Buneviciute J, Hu Q et al. Lithium-induced renal insufficiency: a longitudinal study of creatinine increases in intellectual disabled adults. J Clin Psychoparmacol 2011; 31: 769-773
90 McKnight R, Adida M, Budge K et al. Lithium toxicity profile: a systematic review and meta-analysis. Lancet 2012; 379: 721-728
91 Alexander M, Farag Y, Mittal B et al. Lithium toxicity: a double-edged sword. Kidney Int 2008; 73: 233-237
92 Ibekken C, Becker J, Baumgärtel M. Renal side effects of long-term lithium therapy. Dtsch Med Wochenschr 2012; 137: 143-148
93 DGPPN, BÄK, KBV et al. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Langfassung Januar 2012, Version 1.3. Berlin, Düsseldorf: DGPPN, AZQ, AWMF; 2009
94 AWMF. Leitlinien für Diagnostik und Therapie in der Neurologie: Clusterkopfschmerz und trigeminoautonome Kopfschmerzen. Stuttgart: Georg Thieme Verlag; 2008
95 Belmaker R. Bipolar disorder. N Engl J Med 2004; 351: 476-486