Lithium and the kidney: an update.

It is a little over a decade since Hestbech et al. (1977) reported histological changes in renal biopsy specimens taken from patients who had been treated with lithium. This prompted a flurry of clinical investigations into functional changes in the kidney related to the long-term use of the ion. During the first five years, the majority of these were cross-sectional (Waller & George, 1984) but increasing numbers of longitudinal studies, which attempt to define the risks for individual patients, have since been reported. These have focused on the clinically important aspects of renal function affected by lithium, namely glomerular filtration rate and urine concentrating ability. The more recent studies are considered in this review and recommendations for clinical practice are offered.