Lithium effects on renal functioning: an expert opinion and management algorithm
Year: 2026
Type: article
Abstract: OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Charlotte Strandhave, Hans August Stengaard Hansen, Martin Alda, Michael Bauer, Michael Berk, Pichit Buspavanich, Lasse Brandt, Andre F. Carvalho, Anne Duffy, Orestes Forlenza, Mathilde Frahm Laursen, Mark Frye, Michael Gitlin, Fabiano Alves Gomes, Ana Gonzalez-Pinto, Paul Grof, Tomas Hajek, Sanne V. Hovgesen, Lars Vedel Kessing, Ralph Kupka, Ute Lewitzka, Rasmus W. Licht, Rodrigo Machado-Vieira, Gin S. Malhi, Mirko Manchia, Robert M. Post, Andrea Murru, Andrew A. Nierenberg, Eline Regeer, Eva Reininghaus, Phillip Ritter, Janusz Rybakowski, Balwinder Singh, Gabriele Sani, Christian Simhandl, Rebecca Strawbridge, Trisha Suppes, Mauricio Tohen, Leonardo Tondo, Eduard Vieta, Allan H. Young, René Ernst Nielsen
Institutions: Aalborg University Hospital, Aalborg University, Dalhousie University, University Hospital Carl Gustav Carus, Technische Universität Dresden, Barwon Health, Deakin University, Deutsches Zentrum für Psychische Gesundheit, Charité - Universitätsmedizin Berlin, Queen's University, University of Oxford, Universidade de São Paulo, Mayo Clinic, University of California, Los Angeles, McMaster University, University of the Basque Country, Centro de Investigación Biomédica en Red de Salud Mental, Hospital Universitario Araba, University of Toronto, University of Copenhagen, Capital Region of Denmark, Utrecht University, Dimence, Amsterdam Public Health, GGZ inGeest, Amsterdam University Medical Centers, Goethe University Frankfurt, University Hospital Frankfurt, The University of Texas Health Science Center at Houston, The University of Sydney, Royal North Shore Hospital, Northern Sydney Local Health District, University of Cagliari, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Harvard University, Massachusetts General Hospital, Medical University of Graz, King's College London, Poznan University of Medical Sciences, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Sigmund Freud Privatuniversität Wien, Stanford Medicine, Stanford University, University of New Mexico, McLean Hospital, Universitat de Barcelona, Imperial College London
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
Funders: Ministerio de Ciencia, Innovación y Universidades, Georgia Clinical and Translational Science Alliance, European Commission, Bundesministerium für Bildung und Forschung, Eusko Jaurlaritza, Euskal Herriko Unibertsitatea, Ministerio de Ciencia e Innovación, Centro de Investigación Biomédica en Red de Salud Mental, Berlin University Alliance, National Institutes of Health, National Health and Medical Research Council, Instituto de Salud Carlos III, European Regional Development Fund, National Center for Advancing Translational Sciences
Awards: TRASTORNO BIPOLAR, ESTILO DE VIDA Y ESTRÉS OXIDATIVO, Psych-STRATA - A Stratified Treatment Algorithm in Psychiatry: A program on stratified pharmacogenomics in severe mental illness, G1934591525, G2416132163, G2739718152, Genomic instability and genomic alterations in pre-cancerous lesions and/or cancer, G3667020645, G3853044748, G4644209160, ESTILO DE VIDA EN PRIMER EPISODIO MANIACO Y POTENCIACION FUNCIONAL, Verbundprojekt: Mobiles Gerät zur Lithium-, Natrium- und Kreatinin-Messung für Patienten mit therapieresistenter Depression (LiNaKre) - Teilvorhaben: Untersuchungen zur Pharmakokinetik von Lithium, individualisierbare Therapieoptionen, Validierung, G5654507885, G6033524483, G6326635400, G6844139850, G713478339, El impacto de la puntuación de riesgo poligénico y del trauma temprano en la trayectoria del trastorno bipolar: Un estudio naturalístico longitudinal (PREACT), G7894441833, Institutional Career Development Core
OpenAlex ID: W7155611477