Lithium, an alkali metal, remains the gold-standard of the pharmacological treatment of bipolar disorder. Over the past decades, the potential of lithium to cause renal damage has been an issue of debate. Polyuria, polydipsia, and, to a lesser degree, nephrogenic diabetes insipidus are frequently observed under treatment with lithium. The glomerular filtration rate (GFR) decreases progressively in a smaller proportion of subjects after several years of treatment with lithium. An even smaller number of patients continue to develop renal insufficiency, ultimately leading to hemodialysis in a small minority of subjects exposed to lithium. So far, no tests exist to identify subjects at risk of lithium-induced nephropathy at an early stage. Therefore, regular monitoring of creatinine and creatinine clearance are recommended in all subjects taking lithium.
