Lithium effects on renal functioning: an expert opinion and management algorithm

This expert opinion paper addresses the critical balance between lithium’s therapeutic efficacy in recurrent mood disorders and its potential renal side effects. The objective is to provide evidence-based guidelines to enhance clinical decision-making, prevent emergence of, and mitigate risks associated with lithium-induced renal impairment. An extensive review of epidemiological, observational, and experimental studies on lithium-induced renal impairment, focusing on its pathophysiology, clinical manifestations, and risk factors was conducted. Expert consensus and recent data were integrated to develop a management algorithm for renal monitoring and intervention. Lithium remains the gold standard for mood stabilization in bipolar disorders, with robust evidence supporting its role in recurrence prevention and suicide risk reduction. While mild to moderate renal impairment is recognized as a risk factor, newer studies show a lower incidence of severe outcomes, such as end-stage kidney disease, necessitating dialysis treatment and renal transplantation, especially with appropriate monitoring, as compared to older studies. This paper addresses pathophysiological mechanisms, including arginine vasopressin resistance and chronic interstitial nephritis, alongside risk factors like rapid initial decline in glomerular filtration rate, early age at treatment initiation, cumulative dosage, mean serum levels of lithium and episodes of lithium intoxication. Effective management strategies, including judicious dosing, routine monitoring, and early nephrology referral, can significantly improve outcomes. Lithium remains an invaluable treatment for recurrent mood disorders, and its benefits often outweigh the risks when managed appropriately. This paper provides a practical framework for clinicians to address renal concerns, emphasizing the importance of systematic monitoring and individualized care. The paper underscores the need for continued research and education of clinicians and patients to optimize lithium use while safeguarding patient health.

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Publication Details

Journal
International Journal of Bipolar Disorders
Published
2026-04-25
DOI
https://doi.org/10.1186/s40345-026-00423-z
Primary Topic
Bipolar Disorder and Treatment
Type
article
Field-Weighted Citation Impact
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article

Lithium effects on renal functioning: an expert opinion and management algorithm

Fabiano A. Gomes, Paul Grof, Michael Gitlin, Anne Cecilia Duffy et al.
International Journal of Bipolar Disorders
Bipolar Disorder and Treatment
article

Lithium effects on renal functioning: an expert opinion and management algorithm

Fabiano A. Gomes, Paul Grof, Michael Gitlin, Anne Cecilia Duffy, Charlotte Strandhave, René Ernst Nielsen, Mathilde Frahm Laursen, Lasse Brandt, RASMUS W. LICHT, Christian Simhandl, Pichit Buspavanich, Ute Lewitzka, Andréa Murru, Mark Frye, Eline Regeer, Eva Reininghaus, Orestes Forlenza, Martin Alda, Andre F. Carvalho, Mirko Manchia, Gin S. Malhi, Trisha Suppes, Ralph Kupka, Rodrigo Machado-Vieira, Allan H. Young, Hans August Stengaard Hansen, Balwinder Singh, Gabriele Sani, Robert M. Post, Rebecca Strawbridge, Lars Vedel Kessing, Mauricio Tohen, Tomas Hajek, Andrew A. Nierenberg, Sanne V. Hovgesen, Phillip Ritter, Eduard Vieta, Janusz Rybakowski, Michael Bauer, Ana Gonzalez-Pinto, Leonardo Tondo, Michael Berk
article en

Abstract

This expert opinion paper addresses the critical balance between lithium’s therapeutic efficacy in recurrent mood disorders and its potential renal side effects. The objective is to provide evidence-based guidelines to enhance clinical decision-making, prevent emergence of, and mitigate risks associated with lithium-induced renal impairment. An extensive review of epidemiological, observational, and experimental studies on lithium-induced renal impairment, focusing on its pathophysiology, clinical manifestations, and risk factors was conducted. Expert consensus and recent data were integrated to develop a management algorithm for renal monitoring and intervention. Lithium remains the gold standard for mood stabilization in bipolar disorders, with robust evidence supporting its role in recurrence prevention and suicide risk reduction. While mild to moderate renal impairment is recognized as a risk factor, newer studies show a lower incidence of severe outcomes, such as end-stage kidney disease, necessitating dialysis treatment and renal transplantation, especially with appropriate monitoring, as compared to older studies. This paper addresses pathophysiological mechanisms, including arginine vasopressin resistance and chronic interstitial nephritis, alongside risk factors like rapid initial decline in glomerular filtration rate, early age at treatment initiation, cumulative dosage, mean serum levels of lithium and episodes of lithium intoxication. Effective management strategies, including judicious dosing, routine monitoring, and early nephrology referral, can significantly improve outcomes. Lithium remains an invaluable treatment for recurrent mood disorders, and its benefits often outweigh the risks when managed appropriately. This paper provides a practical framework for clinicians to address renal concerns, emphasizing the importance of systematic monitoring and individualized care. The paper underscores the need for continued research and education of clinicians and patients to optimize lithium use while safeguarding patient health.

International Journal of Bipolar Disorders
Università Cattolica del Sacro Cuore (IT), Goethe University Frankfurt (DE), Poznan University of Medical Sciences (PL), University of Copenhagen (DK), The University of Sydney (AU), Dalhousie University (CA), Barwon Health (AU), Mayo Clinic (US), Harvard University (US), Deakin University (AU), University of California, Los Angeles (US), University of New Mexico (US), University of Cagliari (IT), Universidade de São Paulo (BR), King's College London (GB), University of Toronto (CA), Medical University of Graz (AT), Queen's University (CA), Region Zealand (DK), Aalborg University Hospital (DK), Royal North Shore Hospital (AU), McLean Hospital (US), WinnMed (US), Agostino Gemelli University Polyclinic (IT), Fachhochschule Wiener Neustadt (AT), University of Oxford (GB), Massachusetts General Hospital (US), Dimence (NL), Hospital Universitario Araba (ES), Hospital Clínic de Barcelona (ES), German Centre for Cardiovascular Research (DE), GGZ inGeest (NL), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Capital Region of Denmark (DK), Amsterdam University Medical Centers (NL), Altrecht GGZ (NL), University Hospital Carl Gustav Carus (DE), Imperial College London (GB), Technische Universität Dresden (DE), Charité - Universitätsmedizin Berlin (DE), Aalborg University (DK), The University of Texas Health Science Center at Houston (US), Stanford University (US), McMaster University (CA)
Openalex Percentile: Top 12%
Bipolar Disorder and Treatment
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