Nephrologische Nebenwirkungen einer Langzeittherapie mit Lithium

Zusammenfassung

Lithium-Salze sind Therapie der ersten Wahl in der Phasenprophylaxe bipolarer Störungen. Die Langzeittherapie geht häufig mit Nebenwirkungen einher, welche die Fachgebiete der Nephrologie, der Endokrinologie und der endokrinen Chirurgie berühren. In dieser Übersichtsarbeit werden nephrologische Nebenwirkungen hervorgehoben.

Unter Behandlung mit Lithium wird das gehäufte Auftreten einer Resistenz gegen das antidiuretische Hormon (ADH) mit nephrogenem Diabetes insipidus, ein Lithium-getriggerter Hyperparathyreoidismus mit Hyperkalzämie und eine chronisch-interstitielle Nephritis mit der Bildung von Mikrozysten beobachtet. Langzeit-Patienten haben ein erhöhtes Risiko für die Entwicklung einer chronischen Niereninsuffizienz. Selten kommt es auch zur Dialyse-Abhängigkeit. Die rechtzeitige Beendigung der Lithium-Therapie scheint dies verhindern zu können.

Um die Sicherheit einer Lithium-Therapie zu gewährleisten sind regelmäßige Bestimmungen des Serum-Lithium-Spiegels, Kontrollen der Retentionsparameter, des Spiegels des Thyreoidea stimulierenden Hormons (TSH) und des Kalzium-Spiegels sowie der Urin-Osmolarität essenziell. Rechtzeitig –  also bereits bei einem leichten Anstieg der Retentionsparameter – sollte eine nephrologische bzw. internistische Vorstellung erfolgen.

Abstract

Lithium is widely used in the treatment of bipolar disorders. Long-term administration of lithium often leads to side effects concerning the subjects: nephrology, endocrinology and surgery. This review emphasizes nephrotoxicity.

Lithium treatment may disturb responsiveness to antidiuretic hormone (ADH), causing a nephrogenic diabetes insipidus. Furthermore long-term lithium therapy may trigger hyperparathyreoidism with hypercalcemia and chronic interstitial nephritis with development of microcysts. Long-term patients have an increased risk to develop impaired renal function. Lithium-induced endstage renal disease is rare. Termination of lithium treatment may decrease the risk of progression.

To ensure security of lithium treatment regular controls of urine osmolarity, lithium-, creatinine- , thyroid stimulating hormone- and calcium-levels are essential. Patients with decreased renal function should be referred to a specialist early.

Schlüsselwörter

Lithium - Nephropathie - Mikrozysten - nephrogener Diabetes insipidus - Hyperparathyreoidismus - Nierenfunktion

Keywords

lithium - nephropathy - microcysts - Diabetes insipidus renalis - hyperparathyreoidism - renal function

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