Lithium: long-term effects on the kidney; a prospective follow-up study ten years after kidney biopsy

Article Abstract:

The discovery of lithium's benefits for those who suffer from certain affective disorders such as manic-depression (bipolar disorder) was seen as a virtual miracle. With its widespread use, however, came evidence that some of the side effects could be potentially dangerous. For example, it was believed that chronic treatment with lithium was responsible for kidney dysfunction that could be fatal if untreated. Treatment included being taken off lithium treatment, which in and of itself was unwelcome by those it had helped. The results of studies into possible consequences of long-term use of lithium have been inconsistent, and in each case the design of the study limited observation to between two and five years. This may be too short to allow maximal confidence in conclusions. Likewise, it has only been recently that studies have examined dosage with regard to lithium being taken once daily or in divided doses. There is some evidence that divided doses are more harmful to the kidney than a single dose, even if the total daily amount is the same. Forty patients were identified who had started lithium treatment an average of 20 years prior, and these individuals were followed for a 10-year period. Eight had died and 19 had continued therapy over the years. Data suggested that kidney function remained stable for the patients who had taken lithium for an average of 20 years, but subjects who had multiple daily doses as opposed to one dose did show an irreversible increase in the amount of urine they put out in a day. This may have been indicative of degeneration within the kidney, and biopsy of the kidney supported this speculation. These results support previous findings regarding the effect of lithium dose schedule on the kidneys. While the observed dysfunction did not improve in those switched to once-daily dosing, it did not get progressively worse in those who continued a multiple-dose schedule. It is concluded that impairment of kidney function is related to age, pre-existing kidney disease, treatment schedule, and incidence of lithium overdosage rather than to long-term treatment effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Kidneys, Kidney, Lithium, Lithium (Metal)

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Leucopenia secondary to carbamazepine despite concurrent lithium treatment

Article Abstract:

A reduced white blood cell count (leukopenia) is a commonly reported side effect of carbamazepine (an anticonvulsive drug related to tricyclic antidepressants), which is sometimes used to treat behavioral disorders. Lithium is often administered with carbamazepine, in part because it causes increased white blood cell counts and prevents leukopenia. The case report of a 37-year-old man with manic depression, who developed carbamazepine-related leukopenia despite concurrent treatment with lithium, is presented. He was admitted to a psychiatric hospital in 1988 because he was manic, agitated, overactive, and having grandiose ideas. He had a three-year history of manic-depressive disorder, and had been taking lithium since 1987. The patient was treated with haloperidol (an antipsychotic medication) and continued taking lithium. After several weeks, his condition improved and he was withdrawn from the haloperidol and placed on carbamazepine and lithium maintenance, a combination often found to be effective in preventing manic-depressive relapse. His maintenance levels of carbamazepine were increased over the following month, and lithium levels and white blood cell counts were continually monitored and found to be normal. Five days after the carbamazepine had been increased, he developed a high fever and a frontal headache, accompanied by body rigidity which persisted for several days. His white blood cell count was found to be extremely low. Several days after stopping the carbamazepine, his white blood cell count returned to normal. Although the patient recovered fully, this case indicates that serious leukopenia may occur with carbamazepine despite concurrent administration of lithium. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Leucopenia, Leukopenia

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Isoenzymes of alkaline phosphatase in epileptic patients receiving carbamazepine monotherapy

Article Abstract:

Alkaline phosphatase (ALP) is an enzyme that is made in a wide variety of tissues including the bone, liver, kidney, and intestines. Each tissue makes its own type of ALP and these different types of ALP are called isoenzymes. Measuring the amount of ALP in the blood is a common clinical practice used to evaluate the function of various organs. When the blood levels of ALP are very high, it can be an indication of liver disease, bone disease, or cancer. Recently, it was discovered that anticonvulsant drugs used to treat patients with epilepsy increased the amount of ALP in the blood. One study reported that these types of drugs increased blood levels of ALP by 24 percent in men, 70 percent in women, and 55 percent in children. Another study reported that blood levels of ALP were increased in 21 percent of the patients treated with anticonvulsants. To determine the effect of carbamazepine (CBZ), a commonly prescribed anticonvulsant drug, on blood levels of ALP, 20 female and 21 male epileptic patients were studied. The patients selected for this study had been receiving CBZ for a minimum of two years and had no history of bone or liver disease. The amount of ALP in the blood of the patients treated with CBZ was compared with the amount of ALP in the blood of 32 healthy, normal volunteers, who were not taking anticonvulsant drugs. Blood levels of total ALP (all types of ALP) were higher than normal in 22 percent of the patients taking CBZ. The specific form of ALP that is found in bone was higher than normal in 24 percent of the patients treated with CBZ. It is concluded that the increase in ALP observed in the patients treated with CBZ comes mainly from bone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Isoenzymes, Alkaline phosphatase

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