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Jinnouchi T, Yoshimoto M, Ogino K, Oji T, Hayashi M. Lithium-induced Nephrogenic Diabetes Insipidus with Efficacy of Desmopressin in Combination with Thiazide Diuretics and Non-steroidal Anti-inflammatory Drugs: A Case Report with a Review of the Literature. Intern Med 2024; 63:1399-1404. [PMID: 37779064 PMCID: PMC11157307 DOI: 10.2169/internalmedicine.2437-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/20/2023] [Indexed: 10/03/2023] Open
Abstract
Nephrogenic diabetes insipidus (NDI) is characterized by excessive urination and an inability to concentrate urine. Lithium is the most common cause of acquired NDI. Treatment typically involves thiazide diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs). However, the efficacy of desmopressin in NDI remains unclear. We herein report a case of lithium-induced NDI in a 71-year-old woman with lithium-induced NDI. Thiazide diuretics and NSAIDs reduced the urine output by approximately 40% compared to pretreatment, while the addition of desmopressin reduced it by approximately 70%. This case suggests that desmopressin can be a viable treatment option for lithium-induced NDI.
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Affiliation(s)
- Takanobu Jinnouchi
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
| | - Munehiro Yoshimoto
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
| | - Kei Ogino
- Department of Psychosomatic Medicine, NTT Medical Center Tokyo, Japan
| | - Tomoatsu Oji
- Department of Psychosomatic Medicine, NTT Medical Center Tokyo, Japan
| | - Michio Hayashi
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
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2
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Mahgoub Y, Yapar I, Harbold D. Lithium-Associated Nephrogenic Diabetes Insipidus or Catatonic Stereotypical Drinking?: A Case Report and Literature Review. J Clin Psychopharmacol 2024; 44:187-189. [PMID: 38329376 DOI: 10.1097/jcp.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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Yousef Yengej FA, Pou Casellas C, Ammerlaan CME, Olde Hanhof CJA, Dilmen E, Beumer J, Begthel H, Meeder EMG, Hoenderop JG, Rookmaaker MB, Verhaar MC, Clevers H. Tubuloid differentiation to model the human distal nephron and collecting duct in health and disease. Cell Rep 2024; 43:113614. [PMID: 38159278 DOI: 10.1016/j.celrep.2023.113614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024] Open
Abstract
Organoid technology is rapidly gaining ground for studies on organ (patho)physiology. Tubuloids are long-term expanding organoids grown from adult kidney tissue or urine. The progenitor state of expanding tubuloids comes at the expense of differentiation. Here, we differentiate tubuloids to model the distal nephron and collecting ducts, essential functional parts of the kidney. Differentiation suppresses progenitor traits and upregulates genes required for function. A single-cell atlas reveals that differentiation predominantly generates thick ascending limb and principal cells. Differentiated human tubuloids express luminal NKCC2 and ENaC capable of diuretic-inhibitable electrolyte uptake and enable disease modeling as demonstrated by a lithium-induced tubulopathy model. Lithium causes hallmark AQP2 loss, induces proliferation, and upregulates inflammatory mediators, as seen in vivo. Lithium also suppresses electrolyte transport in multiple segments. In conclusion, this tubuloid model enables modeling of the human distal nephron and collecting duct in health and disease and provides opportunities to develop improved therapies.
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Affiliation(s)
- Fjodor A Yousef Yengej
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW & University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Carla Pou Casellas
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW & University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Carola M E Ammerlaan
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW & University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Charlotte J A Olde Hanhof
- Department of Medical BioSciences, Radboud Institute for Medical Innovation, 6525 GA Nijmegen, the Netherlands
| | - Emre Dilmen
- Department of Medical BioSciences, Radboud Institute for Medical Innovation, 6525 GA Nijmegen, the Netherlands
| | - Joep Beumer
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW, 3584 CT Utrecht, the Netherlands; Institute of Human Biology, Roche Pharma Research and Early Development, 4058 Basel, Switzerland
| | - Harry Begthel
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW, 3584 CT Utrecht, the Netherlands
| | - Elise M G Meeder
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Joost G Hoenderop
- Department of Medical BioSciences, Radboud Institute for Medical Innovation, 6525 GA Nijmegen, the Netherlands
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands.
| | - Hans Clevers
- Hubrecht Institute for Developmental Biology and Stem Cell Research-KNAW & University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Hubrecht Institute-KNAW, 3584 CT Utrecht, the Netherlands.
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Ferreira S, Santos S, Gomes Ferreira S, Fernandes L, Almeida P. Chronic Lithium Intoxication: A Challenging Diagnosis. Cureus 2024; 16:e52626. [PMID: 38374833 PMCID: PMC10876098 DOI: 10.7759/cureus.52626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Lithium has been used in clinical practice since the 1970s. This medication is commonly used to treat and prevent bipolar disorder, but it has a narrow therapeutic index, making toxicity a frequent occurrence. Chronic lithium intoxication can arise due to progressive accumulation, particularly in contexts of dehydration. The effects of chronic lithium intoxication on the nervous, renal, and cardiac systems, as well as on the thyroid and parathyroid glands, are well documented in the literature. The authors present the case of a 66-year-old woman with schizoaffective psychosis and chronic kidney disease, admitted due to altered mental status and dysarthria. Notwithstanding an earlier clinical recommendation to cease lithium administration more than a year ago, the patient continued its usage, culminating in neurological, cardiac, renal, and endocrine manifestations. Although the diagnosis was delayed, her clinical progression was favorable, obviating the need for renal replacement therapy. This case highlights the importance of a detailed medical history and the diagnostic challenges in clinical practice. The use of this drug without proper monitoring can lead to multisystem dysfunction.
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Affiliation(s)
- Sofia Ferreira
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Sara Santos
- Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Sérgio Gomes Ferreira
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Luís Fernandes
- Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Penélope Almeida
- Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT
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5
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Boot C. The laboratory investigation of diabetes insipidus: A review. Ann Clin Biochem 2024; 61:19-31. [PMID: 36650746 DOI: 10.1177/00045632231154391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Diabetes insipidus (DI) is a group of disorders that lead to inappropriate production of large volumes of dilute urine. The three main forms are central DI (CDI), nephrogenic DI (NDI) and primary polydipsia (PP). Differentiating CDI/NDI from PP is important as patients with true DI are at risk of severe dehydration without treatment. Biochemical testing is key in the diagnosis of DI. The indirect water deprivation test (WDT) is commonly used in the investigation of DI but has drawbacks including being cumbersome and sometimes producing equivocal results. Direct measurement of AVP has theoretical advantages but has generally only been used in specialist centres. Disadvantages include the requirement to measure AVP under hypertonic stimulation and pre-analytical/analytical challenges. Copeptin (CT-proAVP) is a proxy marker for AVP that is more stable, easier to measure and has been studied more widely in recent years. Historically, the evidence supporting the diagnostic performance of these tests has been relatively poor, being based on a few small, usually single-centre studies. However more recent, well-designed prospective studies are improving the evidence base for investigation of DI. These studies have focused on the utility of copeptin measurements during stimulation tests. There is evidence that measurement of copeptin under stimulation offers improved diagnostic performance compared to the WDT. There is currently a lack of systematic, evidence-based guidelines on the diagnosis of DI, but as the quality of the evidence defining the diagnostic performance of tests for DI continues to improve, a clearer consensus on the optimal approach should become achievable.
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Affiliation(s)
- Christopher Boot
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Hanna C, Iliuta IA, Besse W, Mekahli D, Chebib FT. Cystic Kidney Diseases in Children and Adults: Differences and Gaps in Clinical Management. Semin Nephrol 2023; 43:151434. [PMID: 37996359 DOI: 10.1016/j.semnephrol.2023.151434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Cystic kidney diseases, when broadly defined, have a wide differential diagnosis extending from recessive diseases with a prenatal or pediatric diagnosis, to the most common autosomal-dominant polycystic kidney disease primarily affecting adults, and several other genetic or acquired etiologies that can manifest with kidney cysts. The most likely diagnoses to consider when assessing a patient with cystic kidney disease differ depending on family history, age stratum, radiologic characteristics, and extrarenal features. Accurate identification of the underlying condition is crucial to estimate the prognosis and initiate the appropriate management, identification of extrarenal manifestations, and counseling on recurrence risk in future pregnancies. There are significant differences in the clinical approach to investigating and managing kidney cysts in children compared with adults. Next-generation sequencing has revolutionized the diagnosis of inherited disorders of the kidney, despite limitations in access and challenges in interpreting the data. Disease-modifying treatments are lacking in the majority of kidney cystic diseases. For adults with rapid progressive autosomal-dominant polycystic kidney disease, tolvaptan (V2-receptor antagonist) has been approved to slow the rate of decline in kidney function. In this article, we examine the differences in the differential diagnosis and clinical management of cystic kidney disease in children versus adults, and we highlight the progress in molecular diagnostics and therapeutics, as well as some of the gaps meriting further attention.
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Affiliation(s)
- Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Ioan-Andrei Iliuta
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Whitney Besse
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Djalila Mekahli
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Fouad T Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL.
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Damba JJ, Bodenstein K, Lavin P, Drury J, Sekhon H, Renoux C, Trinh E, Rej S, Greenway KT. Psychotropic Drugs and Adverse Kidney Effects: A Systematic Review of the Past Decade of Research. CNS Drugs 2022; 36:1049-1077. [PMID: 36161425 DOI: 10.1007/s40263-022-00952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Psychotropic drugs are a heterogenous group of treatments prescribed for many psychiatric disorders, often for long periods. Their effects on the kidney and its functioning are complex and a source of significant research and debate. This article aims to review recent evidence of the acute and chronic kidney adverse events of diverse psychotropes. METHODS A systematic search of randomized controlled trials and large observational studies (n ≥ 100) reporting the effects of psychotropic drugs on the kidney was conducted. The MEDLINE, PsycInfo, and EMBASE databases from 2011 to 2021, inclusive, were broadly searched with few restrictions and no prespecified outcomes. Two or more independent reviewers assessed and summarized all eligible studies, including risks of bias and levels of evidence. RESULTS In all, 1999 abstracts were screened for eligibility and 47 articles were included, which examined lithium (33), antiepileptics (10), antipsychotics (13), and antidepressants (9). No studies examining kidney adverse effects of other psychotropes, such as benzodiazepines, met inclusion criteria. Study populations were adult (8), geriatric (9), and mixed (30). Lithium was almost unanimously associated with (1) chronic kidney disease and (2) nephrogenic diabetes insipidus in methodologically diverse studies. The most supported risk factors for declining kidney functioning with lithium were advanced age, duration of lithium treatment, acute lithium toxicity, female sex, medications with known renal interactions, diabetes mellitus/hyperglycemia, and overall medical comorbidity. Supratherapeutic lithium concentrations are both the causes and consequences of acute kidney injury. Once significant chronic kidney disease has developed, four studies found that replacing lithium with other mood stabilizers does not slow progression, and the evolution to end-stage kidney disease is rare overall with modern practices. Compared to lithium, fewer studies examined antipsychotics and antiepileptics but found relatively less direct kidney harms. Antidepressants were not associated with acute or chronic kidney harms. CONCLUSIONS Despite the heterogeneity of findings, owing to varying methodologies and research challenges, recent studies strongly suggest that lithium is associated with an increased risk of chronic kidney disease and nephrogenic diabetes insipidus, especially in older adults and long-term lithium users. Clinicians should balance the harms of lithium against its established benefits, and ensure adequate monitoring and management of comorbidities in all patients. Weaker evidence suggests that antiepileptics such as valproate and antipsychotics result in comparatively less harm to the kidney than lithium, but warrant monitoring because of multiple direct and indirect mechanisms for potential kidney adverse events. Antidepressants do not have clear kidney adverse effects and appear safe (though potentially less effective) in the setting of kidney disease. Other classes of psychotropic drugs have received little research interest. Further research is warranted, particularly into specific antiepileptics and antipsychotics, and careful attention should be paid to mitigating important sources of bias such as confounding by indication.
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Affiliation(s)
- Joseph Junior Damba
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Katie Bodenstein
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Paola Lavin
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Drury
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Harmehr Sekhon
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kyle T Greenway
- Geri-PARTy Research Group, Lady Davis Research Institute/Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
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8
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Soh JF, Bodenstein K, Yu OHY, Linnaranta O, Renaud S, Mahdanian A, Su CL, Mucsi I, Mulsant B, Herrmann N, Rajji T, Beaulieu S, Sekhon H, Rej S. Atorvastatin lowers serum calcium levels in lithium-users: results from a randomized controlled trial. BMC Endocr Disord 2022; 22:238. [PMID: 36153583 PMCID: PMC9508741 DOI: 10.1186/s12902-022-01145-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although lithium is considered the gold-standard treatment for bipolar disorder (BD), it is associated with a variety of major endocrine and metabolic side effects, including parathyroid hormone (PTH) dependent hypercalcemia. Aside from surgery and medication discontinuation, there are limited treatments for hypercalcemia. This paper will assess data from a randomized controlled trial (RCT). METHODS This is a secondary analysis of an RCT that explored the effects of atorvastatin (n = 27) versus placebo (n = 33) on lithium-induced nephrogenic diabetes insipidus (NDI) in patients with BD and major depressive disorder (MDD) using lithium (n = 60), over a 12-week period. This secondary analysis will explore serum calcium levels and thyroid stimulating hormone (TSH) measured at baseline, week 4, and week 12. RESULTS At 12-weeks follow-up while adjusting results for baseline, linear regression analyses found that corrected serum calcium levels were significantly lower in the treatment group (mean (M) = 2.30 mmol/L, standard deviation (SD) = 0.07) compared to the placebo group (M = 2.33 mmol/L, SD = 0.07) (β = - 0.03 (95% C.I.; - 0.0662, - 0.0035), p = 0.03) for lithium users. There were no significant changes in TSH. CONCLUSION In lithium users with relatively normal calcium levels, receiving atorvastatin was associated with a decrease in serum calcium levels. Although exciting, this is a preliminary finding that needs further investigation with hypercalcemic patients. Future RCTs could examine whether atorvastatin can treat PTH dependent hypercalcemia due to lithium and other causes.
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Affiliation(s)
- Jocelyn Fotso Soh
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada
- Department of Psychology, Concordia University, Montreal, Canada
| | - Katie Bodenstein
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
| | - Oriana Hoi Yun Yu
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
- National Institute for Health and Welfare, Helsinki, Finland
| | - Suzane Renaud
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Artin Mahdanian
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Chien-Lin Su
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Istvan Mucsi
- Multiorgan Transplant Program, University Health Network and Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Centre for Addictions and Mental Health, University of Toronto, Toronto, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Tarek Rajji
- Department of Psychiatry, Centre for Addictions and Mental Health, University of Toronto, Toronto, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Harmehr Sekhon
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada.
- Postdoctoral Research Fellow, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada
- McGill Meditation and Mind-Body Medicine Research Clinic (MMMM-RC), Montreal, Canada
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9
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Schoretsanitis G, de Filippis R, Brady BM, Homan P, Suppes T, Kane JM. Prevalence of impaired kidney function in patients with long-term lithium treatment: A systematic review and meta-analysis. Bipolar Disord 2022; 24:264-274. [PMID: 34783413 DOI: 10.1111/bdi.13154] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although lithium renal effects have been extensively investigated, prevalence rates of chronic kidney disease (CKD) in lithium-treated patients vary. Our aim was to provide prevalence estimates and related moderators. METHODS We performed a systematic review in PubMed/Embase until November 01, 2021, conducting a random effects meta-analysis of studies evaluating CKD prevalence rates in lithium-treated patients calculating overall prevalence ±95% confidence intervals (CIs). Meta-regression analyses included sex, age, body mass index, smoking, hypertension, diabetes, cardiovascular disease, lithium-treatment dose, duration, and blood levels. Subgroup analyses included sample size, diagnoses, and study design. Pooled odds ratios (OR) were estimated for studies including patients receiving nonlithium treatment. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS Five, nine, and six trials were rated as high, fair, and low quality, respectively. In 20 studies (n = 25,907 patients), we estimated an overall prevalence of 25.5% (95% CI = 19.8-32.2) of impaired kidney function; despite lack of differences (p = 0.18), prevalence rates were higher in elderly samples than mixed samples of elderly and nonelderly (35.6%, 95% CI = 21.4-52.9, k = 2, n = 3,161 vs. 25.1%, 95% CI = 19.1-31.3, k = 18, n = 22,746). Prevalence rates were associated with longer lithium treatment duration (p = 0.04). Cross-sectional studies provided lower rates than retrospective studies (14.5%, 95% CI = 13.5-15.5, k = 6, n = 4,758 vs. 29.5%, 95% CI = 22.1-38.0, k = 12, n = 17,988, p < 0.001). Compared with 722,529 patients receiving nonlithium treatment, the OR of impaired kidney function in 14,187 lithium-treated patients was 2.09 (95% CI = 1.24-3.51, k = 8, p = 0.005). CONCLUSIONS One-fourth of patients receiving long-term lithium may develop impaired kidney function, although research suffers from substantial heterogeneity between studies. This risk may be twofold higher compared with nonlithium treatment and may increase for a longer lithium treatment duration.
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Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Department of Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York, USA
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Brian M Brady
- Division of Nephrology, Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Philipp Homan
- University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Department of Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Trisha Suppes
- Stanford University School of Medicine and the US Department of Veterans Affairs Palo Alto Health Care System, Stanford, California, USA
| | - John M Kane
- Department of Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA
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10
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Chronic lithium therapy and urine concentrating ability in individuals with bipolar disorder: association between daily dose and resistance to vasopressin and polyuria. Kidney Int Rep 2022; 7:1557-1564. [PMID: 35812274 PMCID: PMC9263256 DOI: 10.1016/j.ekir.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Lithium treatment can induce nephrogenic diabetes insipidus (NDI), but no consensus intervention is offered to date. We evaluated in these patients patterns of urine concentration and the correlates of 24-hour urine output. Methods Prospective, single-center, observational study of 217 consecutive lithium-treated individuals, with 24-hour urine collection, desmopressin (1-deamino-arginine vasopressin [DDAVP]) concentrating test, fasting plasma vasopressin measurement (copeptin measurement in n = 119), and measured glomerular filtration rate (mGFR). Maximal urine osmolality (MaxUosm) was the highest level during the DDAVP test. Results Of the individuals, 21% displayed polyuria (>3 l/d), but 55% displayed elevated fasting vasopressin level (>5 pg/ml). Uosm was significantly lower and urinary output and free water clearance were significantly higher in individuals treated for >10 years. MaxUosm was >600 mOsm/KgH2O in 128 patients (59%), among which vasopressin was increased in 51%, associated with higher lithium dose (950 [750–1200] vs. 800 [500–1000] mg/d, P < 0.001). All patients with lithium daily dose ≥1400 mg/d had high vasopressin levels. In multivariable analysis, 24-hour urine output was associated with higher lithium daily dose (β 0.49 ± 0.17, P = 0.005), female sex (β −359 ± 123, P = 0.004), daily osmolar intake (β 2.21 ± 0.24, P < 0.001), MaxUosm (β −2.89 ± 0.35, P < 0.001), and plasma vasopressin level (β 10.17 ± 4.76, P = 0.03). Conclusion Higher lithium daily dose was associated with higher vasopressin levels and higher urine output, independently of other factors. Daily osmolar intake was also associated with higher 24-hour urine output. These results suggest that controlled salt and protein intake and lithium dose might reduce polyuria in these patients.
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11
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Rijal SS, Oke I, Shrestha B. Arrhythmia With Lithium Toxicity Requiring Urgent Dialysis: A Case Report. Cureus 2022; 14:e21427. [PMID: 35198331 PMCID: PMC8856736 DOI: 10.7759/cureus.21427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/11/2022] Open
Abstract
Lithium has been widely used as a mood stabilizer. With its narrow therapeutic index, systemic side effects, primarily neurological are a concern. Cardiotoxic effects of lithium are rare, reported as non-specific T-wave flattening, prolonged QT interval, sinus node dysfunction, ventricular tachycardia, cardiomyopathy, and myocardial infarction. We report an interesting case of a young female patient with schizoaffective disorder on lithium who developed life-threatening cardiotoxicity secondary to lithium requiring urgent dialysis.
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Thomsen ML, Grønkjær C, Iervolino A, Rej S, Trepiccione F, Christensen BM. Atorvastatin does not ameliorate nephrogenic diabetes insipidus induced by lithium or potassium depletion in mice. Physiol Rep 2021; 9:e15111. [PMID: 34762363 PMCID: PMC8582289 DOI: 10.14814/phy2.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
Acquired forms of nephrogenic diabetes insipidus (NDI) include lithium (Li)-induced and hypokalemia-induced NDI. Both forms are associated with AQP2 downregulation and collecting duct (CD) cellular remodeling. Statins are cholesterol-lowering drugs appearing to increase AQP2 membrane-translocation and improve urine concentration in other NDI models. We have investigated if statins are able to prevent or rescue the Li-induced changes in mice and in a mouse cortical CD cell line (mCCDc1l ). Biotinylation assays showed that acute (1hr) atorvastatin, simvastatin, or fluvastatin increased AQP2 membrane accumulation in mCCDc1l cells showing that the cell line responds to acute statin treatment. To see whether chronic statin treatment abolish the Li effects, mCCDc1l cells were treated with 48 h Li, combined Li/atorvastatin or combined Li/simvastatin. Li reduced AQP2, but combined Li/atorvastatin or Li/simvastatin did not prevent AQP2 downregulation. In mice, chronic (21 days) Li increased urine output and reduced urine osmolality, but combined Li/atorvastatin did not prevent these effects. In inner medulla (IM), Li reduced total AQP2 and increased pS261-AQP2. Combined Li/atorvastatin did not abolish these changes. Atorvastatin did not prevent a Li-induced increase in intercalated cells and proliferation in IM. In mice with already established NDI, atorvastatin had no effect on the Li-induced changes either. Mice subjected to 14 days of potassium-deficient diet developed polyuria and AQP2 downregulation in IM. Co-treatment with atorvastatin did not prevent this. In conclusion, atorvastatin does not appear to be able to prevent or rescue Li-NDI or to prevent hypokalemic-induced NDI.
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Affiliation(s)
| | | | - Anna Iervolino
- Department of Translational Medical SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
- Biogem Institute of Molecular Biology and GeneticsAriano IrpinoItaly
| | - Soham Rej
- Jewish General Hospital/Lady Davis Institute/Department of PsychiatryMcGill UniversityMontrealQuebecCanada
| | - Francesco Trepiccione
- Department of Translational Medical SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
- Biogem Institute of Molecular Biology and GeneticsAriano IrpinoItaly
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13
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Łukawska E, Frankiewicz D, Izak M, Woźniak A, Dworacki G, Niemir ZI. Lithium toxicity and the kidney with special focus on nephrotic syndrome associated with the acute kidney injury: A case-based systematic analysis. J Appl Toxicol 2021; 41:1896-1909. [PMID: 33798272 DOI: 10.1002/jat.4167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 01/13/2023]
Abstract
Despite the progress made in treating bipolar and unipolar affective disorders, lithium carbonate is still a common drug in psychiatric practice. Lithium-related renal side effects include nephrogenic diabetes insipidus, chronic tubulointerstitial nephropathy, and acute kidney injury (AKI). Nephrotic syndrome (NS) is an uncommon but severe complication of lithium treatment. We present a 49-year-old female treated with lithium carbonate due to a recurrent depressive disorder who developed NS during this therapy. NS spontaneously remitted after the drug withdrawal. Since her lithium serum levels were within the recommended values, we performed a retrospective analysis of lithium-induced NS cases trying to determine causes predisposing to the NS development, underlying histopathology, and preservation or irreversible loss of kidney function. This analysis revealed that in lithium-induced NS with AKI, lithium serum level was the key determinant of AKI development (the β coefficient = 0.8499 with a confidence interval ranging from 0.7452 to 0.9546 and p value < 0.0001). In these cases, the underlying pathology was mainly minimal change disease (MCD), which was quickly reversible upon the drug withdrawal. The development of chronic kidney disease (CKD) seemed to be associated with lithium therapy duration. However, the multiple regression analysis for CKD as the dependent variable showed that the decisive factor was focal segmental glomerulosclerosis (FSGS) as the underlying pathology (the β coefficient = 0.7866 with a confidence interval ranging from 0.600 to 0.9704 and the p value < 0.0001). Thus, we conclude that in lithium-induced NS/AKI, serum lithium levels contribute to these complications, while FSGS lesions are responsible for CKD's disease progression.
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Affiliation(s)
- Emilia Łukawska
- Department of Nephrology, Transplantology and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Monika Izak
- Department of Nephrology, Transplantology and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Aldona Woźniak
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Grzegorz Dworacki
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Zofia I Niemir
- Department of Nephrology, Transplantology and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
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14
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Fotso Soh J, Beaulieu S, Trepiccione F, Linnaranta O, Torres-Platas G, Platt RW, Renaud S, Su CL, Mucsi I, D'Apolito L, Mulsant BH, Levinson A, Saury S, Müller D, Schaffer A, Dols A, Low N, Cervantes P, Christensen BM, Herrmann N, Rajji T, Rej S. A double-blind, randomized, placebo-controlled pilot trial of atorvastatin for nephrogenic diabetes insipidus in lithium users. Bipolar Disord 2021; 23:66-75. [PMID: 32621644 DOI: 10.1111/bdi.12973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Lithium remains an important treatment for mood disorders but is associated with kidney disease. Nephrogenic diabetes insipidus (NDI) is associated with up to 3-fold risk of incident chronic kidney disease among lithium users. There are limited randomized controlled trials (RCT) for treatments of lithium-induced NDI, and existing therapies can be poorly tolerated. Therefore, novel treatments are needed for lithium-induced NDI. METHOD We conducted a 12-week double-blind pilot RCT to assess the feasibility and efficacy of 20 mg/d atorvastatin vs placebo in the treatment of NDI in chronic lithium users. Patients, recruited between September 2017 and October 2018, were aged 18 to 85, currently on a stable dose of lithium, and determined to have NDI. RESULTS Urinary osmolality (UOsm) at 12 weeks adjusted for baseline was not statistically different between groups (+39.6 mOsm/kg [95% CI, -35.3, 114.5] in atorvastatin compared to placebo groups). Secondary outcomes of fluid intake and aquaporin-2 excretions at 12 weeks adjusted for baseline were -0.13 L [95% CI, -0.54, 0.28] and 98.68 [95% CI, -190.34, 387.70], respectively. A moderate effect size was observed for improvements in baseline UOsm by ≥100 mOsm/kg at 12 weeks in patients who received atorvastatin compared to placebo (38.45% (10/26) vs 22.58% (7/31); Cohen's d = 0.66). CONCLUSION Among lithium users with NDI, atorvastatin 20 mg/d did not significantly improve urinary osmolality compared to placebo over a 12-week period. Larger confirmatory trials with longer follow-up periods may help to further assess the effects of statins on NDI, especially within patients with more severe NDI.
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Affiliation(s)
- Jocelyn Fotso Soh
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Serge Beaulieu
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Outi Linnaranta
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, QC, Canada
| | - Suzane Renaud
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Chien-Lin Su
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, QC, Canada
| | - Istvan Mucsi
- Division of Nephrology, University Health Network, University of Toronto (UofT), Toronto, ON, Canada
| | - Luciano D'Apolito
- Biogem S.c.a.r.l., Istituto di Ricerche Genetiche "Gaetano Salvatore", Ariano Irpino, Italy
| | - Benoit H Mulsant
- Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea Levinson
- Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sybille Saury
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Daniel Müller
- Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Annemiek Dols
- Amsterdam UMC, Department of Psychiatry, GGZinGeest, Neuroscience, Amsterdam, The Netherlands
| | - Nancy Low
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Pablo Cervantes
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | | | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Tarek Rajji
- Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
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15
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Pinna M, Manchia M, Visioli C, Tondo L. Clinical response and metabolic effects of lithium in 323 mood disorder patients. J Affect Disord 2020; 270:9-14. [PMID: 32275226 DOI: 10.1016/j.jad.2020.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 03/22/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Lithium is the mainstay for the maintenance treatment of mood disorders (MD), but its efficacy needs to be weighed against its side effects profile. Here, we assessed retrospectively the clinical response to long-term lithium treatment, as well as the rate of associated metabolic side effects. METHODS Clinical data were collected from patients treated with lithium for at least 12 months at the Lucio Bini Center for Mood Disorders in Cagliari, Italy. Clinical response was determined as the difference in number of mood episodes and percent of illness time before and during lithium treatment. Symptomatic values of metabolic parameters (plasma levels of glucose, cholesterol, urea nitrogen [BUN], creatinine, TSH, white blood cells [WBC]), and Body Mass Index (BMI) were determined. RESULTS We studied 323 MD patients (60.2% women). The percent of illness time was significantly reduced for both depressive (F = 4.94, p<0.0001), and manic (F = 3.95, p < 0.0001) episodes, whereas the rates of episodes/year were significantly reduced for mania (F = 2.01, p = 0.02), but not for depression (F = 1.54, p = 0.06). Rates of MD patients with symptomatic values of metabolic parameters were 14.3% for WBC ≥10,000/µl, 26.9% for glucose levels ≥100 mg/dl, 54.2% for cholesterol levels ≥200 mg/dl, 7.5% for BUN ≥50 mg/dl, 21.9% for creatinine levels ≥1.2 mg/dl, and 20.9% for TSH levels ≥3.50 mU/l. CONCLUSIONS Long-term lithium treatment was clinically effective, but the rates of metabolic effects were substantial although some of them were also associated with older age. Lithium-treated patients should receive accurate clinical monitoring to decrease the impact of long-term side effects.
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Affiliation(s)
- Marco Pinna
- Mood Disorder Lucio Bini Center, Cagliari, Italy; Unit of Psychiatry, Department of Mental Health, Santissima Trinità Hospital, Cagliari, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | - Leonardo Tondo
- Mood Disorder Lucio Bini Center, Cagliari, Italy; McLean Hospital-Harvard University, Boston, United States
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16
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Kovvuru K, Kanduri SR, Thongprayoon C, Cheungpasitporn W. Lithium and nephrotoxicity: Nephrology's perspectives. Bipolar Disord 2020; 22:331-333. [PMID: 32338392 DOI: 10.1111/bdi.12916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karthik Kovvuru
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Swetha R Kanduri
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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17
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Jacob JE, Chng WQ, Teo DB. Looking Beyond Numbers: Lithium Toxicity Within Therapeutic Levels. Am J Med 2020; 133:e155-e156. [PMID: 31647912 DOI: 10.1016/j.amjmed.2019.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan Edward Jacob
- Senior Resident, Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore.
| | - Wei Qiang Chng
- Resident, Internal Medicine, University Medical Cluster, National University Hospital, National University Health System, Singapore
| | - Desmond B Teo
- Consultant, Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore; Instructor, Yong Loo Lin School of Medicine, National University of Singapore
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18
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Real-time particle-by-particle detection of erythrocyte-camouflaged microsensor with extended circulation time in the bloodstream. Proc Natl Acad Sci U S A 2020; 117:3509-3517. [PMID: 32019879 DOI: 10.1073/pnas.1914913117] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Personalized medicine offers great potential benefits for disease management but requires continuous monitoring of drugs and drug targets. For instance, the therapeutic window for lithium therapy of bipolar disorder is very narrow, and more frequent monitoring of sodium levels could avoid toxicity. In this work, we developed and validated a platform for long-term, continuous monitoring of systemic analyte concentrations in vivo. First, we developed sodium microsensors that circulate directly in the bloodstream. We used "red blood cell mimicry" to achieve long sensor circulation times of up to 2 wk, while being stable, reversible, and sensitive to sodium over physiologically relevant concentration ranges. Second, we developed an external optical reader to detect and quantify the fluorescence activity of the sensors directly in circulation without having to draw blood samples and correlate the measurement with a phantom calibration curve to measure in vivo sodium. The reader design is inherently scalable to larger limbs, species, and potentially even humans. In combination, this platform represents a paradigm for in vivo drug monitoring that we anticipate will have many applications in the future.
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19
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Jobbagy S, Vitturi DA, Salvatore SR, Pires MF, Rowart P, Emlet DR, Ross M, Hahn S, St Croix C, Wendell SG, Subramanya AR, Straub AC, Tan RJ, Schopfer FJ. Nrf2 activation protects against lithium-induced nephrogenic diabetes insipidus. JCI Insight 2020; 5:128578. [PMID: 31941842 DOI: 10.1172/jci.insight.128578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
Lithium (Li) is the mainstay pharmacotherapeutic mood stabilizer in bipolar disorder. Its efficacious use is complicated by acute and chronic renal side effects, including nephrogenic diabetes insipidus (NDI) and progression to chronic kidney disease (CKD). The nuclear factor erythroid-derived 2-related factor 2 (Nrf2) pathway senses and coordinates cellular responses to oxidative and electrophilic stress. Here, we identify that graded genetic activation of Nrf2 protects against Li-induced NDI (Li-NDI) and volume wasting via an aquaporin 2-independent mechanism. Renal Nrf2 activity is differentially expressed on functional segments of the nephron, and its activation along the distal tubule and collecting duct directly modulates ion transporter expression, mimicking paradoxical effects of diuretics in mitigating Li-NDI. In addition, Nrf2 reduces cyclooxygenase expression and vasoactive prostaglandin biosynthesis. Pharmacologic activation of Nrf2 confers protective effects, confirming this pathway as a potentially novel druggable target for the prevention of acute and chronic renal sequelae of Li therapy.
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Affiliation(s)
| | - Dario A Vitturi
- Department of Pharmacology and Chemical Biology.,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | | | | | | | - David R Emlet
- Center for Critical Care Nephrology, Department of Critical Care Medicine
| | | | - Scott Hahn
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | | | - Stacy G Wendell
- Department of Pharmacology and Chemical Biology.,Health Sciences Metabolomics and Lipidomics Core, and
| | - Arohan R Subramanya
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam C Straub
- Department of Pharmacology and Chemical Biology.,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | - Roderick J Tan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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20
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Volkmann C, Bschor T, Köhler S. Lithium Treatment Over the Lifespan in Bipolar Disorders. Front Psychiatry 2020; 11:377. [PMID: 32457664 PMCID: PMC7221175 DOI: 10.3389/fpsyt.2020.00377] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
Lithium has been the treatment of choice for patients with bipolar disorder (BD) for nearly 70 years. It is recommended by all relevant guidelines as a first-line treatment for maintenance therapy. In this review, we outline the current state of evidence for lithium in the treatment of BD over the lifespan. First, we summarize the evidence on efficacy in general, from relapse prevention to acute anti-manic treatment and its role in treating mood episodes with mixed features and bipolar depression. As patients are often treated for many years and different aspects have to be considered in different phases of life, we discuss the particularities of lithium in the treatment of paediatric BD, in older aged individuals and in pregnant women. Lastly, we discuss the evidence on lithium's proposed suicide-preventive effects, the dangers of rapid discontinuation and lithium's adverse effects, particularly with regard to long-term treatment.
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Affiliation(s)
- Constantin Volkmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tom Bschor
- Department of Psychiatry, Schlosspark Hospital Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Tingskov SJ, Mutsaers HAM, Nørregaard R. Estrogen regulates aquaporin-2 expression in the kidney. VITAMINS AND HORMONES 2019; 112:243-264. [PMID: 32061343 DOI: 10.1016/bs.vh.2019.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Estrogens are primarily identified as sex hormones that, for a long time, have been known as important regulators of female reproductive physiology. However, our understanding of the role of estrogens has changed over the past years. It is now well accepted that estrogens are also involved in other physiological and pathological processes in both genders. This is due to the fact that estrogen can act both local as well as on a systemic level. Next to its role in reproductive physiology, there is accumulating evidence that estrogen influences multiple systems involved in water homeostasis. This chapter will delineate the regulatory effects of estrogen on the water channel aquaporin-2 (AQP2) found in the renal collecting duct. We will first provide an introduction to estrogen, the estrogen receptors and their role in renal physiology as well as describe the effect of selective estrogen receptor modulators (SERMs) on the kidney. Subsequently, we will focus on how estrogen and SERMs influence water balance and regulate AQP2 expression in principal cells of the collecting duct. Finally, we will describe how estrogen regulates AQP2 functionality in other organ systems.
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Affiliation(s)
| | | | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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22
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Wang H, Huang B, Wang W, Li J, Chen Y, Flynn T, Zhao M, Zhou Z, Lin X, Zhang Y, Xu M, Li K, Tian K, Yuan D, Zhou P, Hu L, Zhong D, Zhu S, Li J, Chen D, Wang K, Liang J, He Q, Sun J, Shi J, Yan L, Sands JM, Xie Z, Lian X, Xu D, Ran J, Yang B. High urea induces depression and LTP impairment through mTOR signalling suppression caused by carbamylation. EBioMedicine 2019; 48:478-490. [PMID: 31628020 PMCID: PMC6838447 DOI: 10.1016/j.ebiom.2019.09.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Urea, the end product of protein metabolism, has been considered to have negligible toxicity for a long time. Our previous study showed a depression phenotype in urea transporter (UT) B knockout mice, which suggests that abnormal urea metabolism may cause depression. The purpose of this study was to determine if urea accumulation in brain is a key factor causing depression using clinical data and animal models. METHODS A meta-analysis was used to identify the relationship between depression and chronic diseases. Functional Magnetic Resonance Imaging (fMRI) brain scans and common biochemical indexes were compared between the patients and healthy controls. We used behavioural tests, electrophysiology, and molecular profiling techniques to investigate the functional role and molecular basis in mouse models. FINDINGS After performing a meta-analysis, we targeted the relevance between chronic kidney disease (CKD) and depression. In a CKD mouse model and a patient cohort, depression was induced by impairing the medial prefrontal cortex. The enlarged cohort suggested that urea was responsible for depression. In mice, urea was sufficient to induce depression, interrupt long-term potentiation (LTP) and cause loss of synapses in several models. The mTORC1-S6K pathway inhibition was necessary for the effect of urea. Lastly, we identified that the hydrolysate of urea, cyanate, was also involved in this pathophysiology. INTERPRETATION These data indicate that urea accumulation in brain is an independent factor causing depression, bypassing the psychosocial stress. Urea or cyanate carbamylates mTOR to inhibit the mTORC1-S6K dependent dendritic protein synthesis, inducing impairment of synaptic plasticity in mPFC and depression-like behaviour. CKD patients may be able to attenuate depression only by strict management of blood urea.
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Affiliation(s)
- Hongkai Wang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China; Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Boyue Huang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Weiling Wang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Jinfang Li
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Chen
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Trevor Flynn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Meng Zhao
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiming Zhou
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojing Lin
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yinan Zhang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China; National Institute on Drug Dependence, Peking University, Bejing, China
| | - Mengmeng Xu
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Keqiong Li
- Chongqing Cancer Research Institute, Chongqing, China
| | - Kuan Tian
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Dezhi Yuan
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Zhou
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Ling Hu
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Dandan Zhong
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Shuai Zhu
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Jing Li
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Dilong Chen
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China; Chongqing Three Gorges Medical College, Chongqing, China
| | - Kejian Wang
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China
| | - Jianhui Liang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China; National Institute on Drug Dependence, Peking University, Bejing, China
| | - Qihua He
- Center of Medical and Health Analysis, Peking University, Beijing, China
| | - Jianbin Sun
- Clinical Laboratory, Peking University Third Hospital, Beijing, China
| | - Jie Shi
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China; National Institute on Drug Dependence, Peking University, Bejing, China
| | - Li Yan
- Ion Channel Explorer Bioscience INC., Beijing, China
| | - Jeff M Sands
- Renal Division, Department of Medicine and Department of Physiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zhengwei Xie
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Xuemei Lian
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jianhua Ran
- Department of Anatomy, and Laboratory of Neuroscience and Tissue Engineering, Basic Medical College, Chongqing Medical University, Chongqing, China.
| | - Baoxue Yang
- Department of Pharmacology, School of Basic Medical Sciences, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China.
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de Groot T, Ebert LK, Christensen BM, Andralojc K, Cheval L, Doucet A, Mao C, Baumgarten R, Low BE, Sandhoff R, Wiles MV, Deen PMT, Korstanje R. Identification of Acer2 as a First Susceptibility Gene for Lithium-Induced Nephrogenic Diabetes Insipidus in Mice. J Am Soc Nephrol 2019; 30:2322-2336. [PMID: 31558682 DOI: 10.1681/asn.2018050549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/07/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lithium, mainstay treatment for bipolar disorder, causes nephrogenic diabetes insipidus and hypercalcemia in about 20% and 10% of patients, respectively, and may lead to acidosis. These adverse effects develop in only a subset of patients treated with lithium, suggesting genetic factors play a role. METHODS To identify susceptibility genes for lithium-induced adverse effects, we performed a genome-wide association study in mice, which develop such effects faster than humans. On day 8 and 10 after assigning female mice from 29 different inbred strains to normal chow or lithium diet (40 mmol/kg), we housed the animals for 48 hours in metabolic cages for urine collection. We also collected blood samples. RESULTS In 17 strains, lithium treatment significantly elevated urine production, whereas the other 12 strains were not affected. Increased urine production strongly correlated with lower urine osmolality and elevated water intake. Lithium caused acidosis only in one mouse strain, whereas hypercalcemia was found in four strains. Lithium effects on blood pH or ionized calcium did not correlate with effects on urine production. Using genome-wide association analyses, we identified eight gene-containing loci, including a locus containing Acer2, which encodes a ceramidase and is specifically expressed in the collecting duct. Knockout of Acer2 led to increased susceptibility for lithium-induced diabetes insipidus development. CONCLUSIONS We demonstrate that genome-wide association studies in mice can be used successfully to identify susceptibility genes for development of lithium-induced adverse effects. We identified Acer2 as a first susceptibility gene for lithium-induced diabetes insipidus in mice.
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Affiliation(s)
- Theun de Groot
- The Jackson Laboratory, Bar Harbor, Maine.,Departments of Physiology.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Lena K Ebert
- The Jackson Laboratory, Bar Harbor, Maine.,Departments of Physiology.,Department II of Internal Medicine, Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Karolina Andralojc
- Molecular Biology.,Biochemistry, and.,Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lydie Cheval
- Cordeliers Research Center, Sorbonne University, Pierre and Marie Curie University Paris 06, INSERM (Institut National de la Santé et de la Recherche Médicale), Paris Descartes University, Sorbonne Paris Cité, UMR_S (Unité Mixte de Recherche en Sciences) 1138, Paris, France.,Physiology of Renal and Tubulopathies, CNRS (Centre National de la Recherche Scientifique) ERL 8228, Cordeliers Research Center, INSERM, Sorbonne University, Sorbonne Paris Cité University, Paris Descartes University, Paris Diderot University, Paris, France
| | - Alain Doucet
- Cordeliers Research Center, Sorbonne University, Pierre and Marie Curie University Paris 06, INSERM (Institut National de la Santé et de la Recherche Médicale), Paris Descartes University, Sorbonne Paris Cité, UMR_S (Unité Mixte de Recherche en Sciences) 1138, Paris, France
| | - Cungui Mao
- Department of Medicine, Stony Brook University, Stony Brook, New York.,Stony Brook Cancer Center, Stony Brook, New York
| | | | | | - Roger Sandhoff
- Lipid Pathobiochemistry Group, Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany; and.,Centre for Applied Sciences at Technical Universities (ZAFH)-Applied Biomedical Mass Spectrometry (ABIMAS), Mannheim, Germany
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Şenocak Taşçi E, Eralp H, Kayataş K. LITHIUM-INDUCED NEPHROGENIC DIABETES INSIPIDUS RESPONSIVE TO DESMOPRESSIN. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:270-271. [PMID: 31508188 DOI: 10.4183/aeb.2019.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nephrogenic diabetes insipidus (NDI) is the most common renal side effect seen with lithium therapy. Persisting cases after the cessation of the therapy may be seen when lithium therapy is continued for too long. Although desmopressin treatment is not one of the accepted treatment modalities for NDI, there are few reports using desmopressin treatment in unresponsive cases. Herein, we reported the fourth lithium-induced NDI case in the literature responsive to desmopressin therapy.
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Affiliation(s)
- E Şenocak Taşçi
- Department of Internal Medicine, Haydarpasa Numune Research and Teaching Hospital, Istanbul, Turkey
| | - H Eralp
- Department of Internal Medicine, Haydarpasa Numune Research and Teaching Hospital, Istanbul, Turkey
| | - K Kayataş
- Department of Internal Medicine, Haydarpasa Numune Research and Teaching Hospital, Istanbul, Turkey
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25
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Abstract
Diabetes insipidus (DI) is a disorder characterized by excretion of large amounts of hypotonic urine. Central DI results from a deficiency of the hormone arginine vasopressin (AVP) in the pituitary gland or the hypothalamus, whereas nephrogenic DI results from resistance to AVP in the kidneys. Central and nephrogenic DI are usually acquired, but genetic causes must be evaluated, especially if symptoms occur in early childhood. Central or nephrogenic DI must be differentiated from primary polydipsia, which involves excessive intake of large amounts of water despite normal AVP secretion and action. Primary polydipsia is most common in psychiatric patients and health enthusiasts but the polydipsia in a small subgroup of patients seems to be due to an abnormally low thirst threshold, a condition termed dipsogenic DI. Distinguishing between the different types of DI can be challenging and is done either by a water deprivation test or by hypertonic saline stimulation together with copeptin (or AVP) measurement. Furthermore, a detailed medical history, physical examination and imaging studies are needed to ensure an accurate DI diagnosis. Treatment of DI or primary polydipsia depends on the underlying aetiology and differs in central DI, nephrogenic DI and primary polydipsia.
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26
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Pickard BS. Genomics of Lithium Action and Response. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:308-313. [PMID: 32015722 PMCID: PMC6996056 DOI: 10.1176/appi.focus.17305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Neurotherapeutics (2017) 14:582-587).
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Abstract
Objectives:
Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.
Methods:
This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.
Results:
Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.
Conclusions:
Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships.
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Abstract
Besides its efficiency, lithium has a narrow therapeutic index and can result in considerable toxicity. Among the potential side effects, two types of renal toxicity are observed: a decreased renal concentrating ability and a chronic renal failure. Lithium-induced polyuria is frequent, estimated to affect up to 40% of patients, and develops usually early. It may be irreversible, especially if the treatment has been prescribed for more than 15 years. A chronic renal failure is observed in patients treated for more than 10 to 20 years. Its prevalence is estimated at 12% after 19 years of treatment. Some patients (0.5%) may reach end stage renal disease. The major risk factor is the duration of exposure to lithium. Discussion about stopping or not lithium in case of renal failure needs multidisciplinary expertise and depends on psychiatric status and renal function.
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Affiliation(s)
- Aude Servais
- Service de néphrologie adulte, hôpital Necker, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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29
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Abstract
INTRODUCTION Hyponatremia is the most common electrolyte disorder with a prevalence of up to 30% in hospitalized patients. Furthermore, it is associated with increased morbidity and mortality. AREAS COVERED This review discusses the efficacy and side effects of the currently available treatment options for hyponatremia and the differences in the pharmacological approach between the European and USA guidelines. Additionally, the authors provide their expert perspectives on current treatment strategies and what they expect from this field in the future. EXPERT OPINION Several pharmacological options are available for the treatment of hyponatremia, but data from trials examining and comparing these treatments are missing. Regarding chronic hyponatremia, the role of vaptans should be further analyzed, focusing on comparisons with other active treatments on patient-relevant outcomes and not only on serum sodium concentration. Clinicians should be cautious to an overly rapid increase in serum sodium levels with all available treatment strategies. Finally, it is important to ascertain whether correction of serum sodium levels improves mortality in hyponatremic patients.
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Affiliation(s)
- Theodosios Filippatos
- a Department of Internal Medicine, School of Medicine , University of Crete , Crete , Greece
| | - Moses Elisaf
- b Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - George Liamis
- b Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
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30
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Fotso Soh J, Torres-Platas SG, Beaulieu S, Mantere O, Platt R, Mucsi I, Saury S, Renaud S, Levinson A, Andreazza AC, Mulsant BH, Müller D, Schaffer A, Dols A, Cervantes P, Low NCP, Herrmann N, Christensen BM, Trepiccione F, Rajji T, Rej S. Atorvastatin in the treatment of Lithium-induced nephrogenic diabetes insipidus: the protocol of a randomized controlled trial. BMC Psychiatry 2018; 18:227. [PMID: 30012135 PMCID: PMC6048831 DOI: 10.1186/s12888-018-1793-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/14/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Lithium is the gold-standard treatment for bipolar disorder, is highly effective in treating major depressive disorder, and has anti-suicidal properties. However, clinicians are increasingly avoiding lithium largely due to fears of renal toxicity. Nephrogenic Diabetes Insipidus (NDI) occurs in 15-20% of lithium users and predicts a 2-3 times increased risk of chronic kidney disease (CKD). We recently found that use of statins is associated with lower NDI risk in a cross-sectional study. In this current paper, we describe the methodology of a randomized controlled trial (RCT) to treat lithium-induced NDI using atorvastatin. METHODS We will conduct a 12-week, double-blind placebo-controlled RCT of atorvastatin for lithium-induced NDI at McGill University, Montreal, Canada. We will recruit 60 current lithium users, aged 18-85, who have indicators of NDI, which we defined as urine osmolality (UOsm) < 600 mOsm/kg after 10-h fluid restriction. We will randomize patients to atorvastatin (20 mg/day) or placebo for 12 weeks. We will examine whether this improves measures of NDI: UOsm and aquaporin (AQP2) excretion at 12-week follow-up, adjusted for baseline. RESULTS Not applicable. CONCLUSION The aim of this clinical trial is to provide preliminary data about the efficacy of atorvastatin in treating NDI. If successful, lithium could theoretically be used more safely in patients with a reduced subsequent risk of CKD, hypernatremia, and acute kidney injury (AKI). If future definitive trials confirm this, this could potentially allow more patients to benefit from lithium, while minimizing renal risk. TRIAL REGISTRATION ClinicalTrials.gov NCT02967653 . Registered in February 2017.
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Affiliation(s)
- Jocelyn Fotso Soh
- Geri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, 4333 Cote Ste-Catherine, Montreal, QC, H3T, 1E4, Montreal, Canada.
| | - Susana G. Torres-Platas
- 0000 0004 1936 8649grid.14709.3bGeri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, 4333 Cote Ste-Catherine, Montreal, QC, H3T, 1E4, Montreal, Canada
| | - Serge Beaulieu
- 0000 0004 1936 8649grid.14709.3bDouglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
| | - Outi Mantere
- 0000 0004 1936 8649grid.14709.3bDouglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
| | - Robert Platt
- 0000 0000 9064 4811grid.63984.30Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Canada
| | - Istvan Mucsi
- 0000 0001 2157 2938grid.17063.33Division of Nephrology, University Health Network, University of Toronto (UofT), Toronto, Canada
| | - Sybille Saury
- 0000 0004 1936 8649grid.14709.3bDouglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
| | - Suzane Renaud
- 0000 0004 1936 8649grid.14709.3bDouglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
| | - Andrea Levinson
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ana C. Andreazza
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benoit H. Mulsant
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniel Müller
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Annemiek Dols
- Department of Psychiatry, GGZ, Geest, Amsterdam, the Netherlands
| | - Pablo Cervantes
- 0000 0000 9064 4811grid.63984.30Department of Psychiatry, McGill University Health Centre, Montreal, Canada
| | - Nancy CP Low
- 0000 0000 9064 4811grid.63984.30Department of Psychiatry, McGill University Health Centre, Montreal, Canada
| | - Nathan Herrmann
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Birgitte M. Christensen
- 0000 0001 1956 2722grid.7048.bDepartment of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Francesco Trepiccione
- 0000 0001 0790 385Xgrid.4691.aDivision of Nephrology, University of Naples, Naples, Italy
| | - Tarek Rajji
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Soham Rej
- 0000 0004 1936 8649grid.14709.3bGeri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, 4333 Cote Ste-Catherine, Montreal, QC, H3T, 1E4, Montreal, Canada ,0000 0004 1936 8649grid.14709.3bDouglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, Canada
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Macau RA, da Silva TN, Silva JR, Ferreira AG, Bravo P. Use of acetazolamide in lithium-induced nephrogenic diabetes insipidus: a case report. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM-17-0154. [PMID: 29479446 PMCID: PMC5820740 DOI: 10.1530/edm-17-0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/16/2018] [Indexed: 11/20/2022] Open
Abstract
Lithium-induced nephrogenic diabetes insipidus (Li-NDI) is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series). We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients.
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Affiliation(s)
| | | | | | | | - Pedro Bravo
- Nephrology Department, Hospital Garcia de Orta
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32
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Tingskov SJ, Hu S, Frøkiær J, Kwon TH, Wang W, Nørregaard R. Tamoxifen attenuates development of lithium-induced nephrogenic diabetes insipidus in rats. Am J Physiol Renal Physiol 2018; 314:F1020-F1025. [PMID: 29357422 DOI: 10.1152/ajprenal.00604.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lithium is widely used in treatment of bipolar affective disorders but often causes nephrogenic diabetes insipidus (NDI), a disorder characterized by severe urinary-concentrating defects. Lithium-induced NDI is caused by lithium uptake by collecting duct principal cells and altered expression of aquaporin-2 (AQP2), which are essential for water reabsorption of tubular fluid in the collecting duct. Sex hormones have previously been shown to affect the regulation of AQP2, so we tested whether tamoxifen (TAM), a selective estrogen receptor modulator, would attenuate lithium-induced alterations on renal water homeostasis. Rats were treated for 14 days with lithium, and TAM treatment was initiated 1 wk after onset of lithium administration. Lithium treatment resulted in severe polyuria and reduced AQP2 expression, which were ameliorated by TAM. Consistent with this, TAM attenuated downregulation of AQP2 and increased phosphorylation of the cAMP-responsive element-binding protein, which induced AQP2 expression in freshly isolated inner-medullary collecting duct suspension prepared from lithium-treated rats. In conclusion, TAM attenuated polyuria dose dependently and impaired urine concentration and downregulation of AQP2 protein expression in rats with lithium-induced NDI. These findings suggest that TAM is likely to be a novel therapeutic option for lithium-induced NDI.
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Affiliation(s)
| | - Shan Hu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangdong , China
| | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - Tae-Hwan Kwon
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University , Daegu , Korea
| | - Weidong Wang
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangdong , China
| | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University , Aarhus , Denmark
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Maddala RNM, Ashwal AJ, Rao MS, Padmakumar R. Chronic lithium intoxication: Varying electrocardiogram manifestations. Indian J Pharmacol 2017; 49:127-129. [PMID: 28458438 PMCID: PMC5351227 DOI: 10.4103/ijp.ijp_204_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lithium is a commonly used drug in psychiatric practice. It is used in the treatment of depression and bipolar disorder. It has a narrow therapeutic index with documented adverse effects even near therapeutic levels. It has myriad of manifestations at toxic levels. The cardiovascular effects range from relatively benign ST-T wave changes to fatal arrhythmias. We describe a case of lithium toxicity which presented as a junctional rhythm and later showed a variety of manifestations such as complete heart block, atrial fibrillation, sinus bradycardia, and finally reverted to sinus rhythm at par with serum lithium levels.
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Affiliation(s)
| | - A J Ashwal
- Department of Cardiology, KMC, Manipal University, Manipal, Udupi, Karnataka, India
| | - M Sudhakar Rao
- Department of Cardiology, KMC, Manipal University, Manipal, Udupi, Karnataka, India
| | - R Padmakumar
- Department of Cardiology, KMC, Manipal University, Manipal, Udupi, Karnataka, India
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Abstract
Lithium has been used for the management of psychiatric illnesses for over 50 years and it continues to be regarded as a first-line agent for the treatment and prevention of bipolar disorder. Lithium possesses a narrow therapeutic index and comparatively minor alterations in plasma concentrations can have significant clinical sequelae. Several drug classes have been implicated in the development of lithium toxicity over the years, including diuretics and non-steroidal anti-inflammatory compounds, but much of the anecdotal and experimental evidence supporting these interactions is dated, and many newer medications and medication classes have been introduced during the intervening years. This review is intended to provide an update on the accumulated evidence documenting potential interactions with lithium, with a focus on pharmacokinetic insights gained within the last two decades. The clinical relevance and ramifications of these interactions are discussed.
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Affiliation(s)
- Patrick R Finley
- School of Pharmacy, University of California at San Francisco, 3333 California Street, Box 0613, San Francisco, CA, 94143-0613, USA.
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35
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Abstract
Lithium is the most successful mood stabilizer treatment for bipolar disorder. However, unlike conventional drugs that are designed to interact with a specific molecular target, the actions of lithium are distributed across many biological processes and pathways. Treatment response is subject to genetic variation between individuals and similar genetic variation may dictate susceptibility to side effects. Transcriptomic, genomic, and cell-model research strategies have all been deployed in the search for the genetic factors and biological systems that mediate the interaction between genetics and the therapeutic actions of lithium. In this review, recent findings from genome-wide studies and patient cell lines will be summarized and discussed from a standpoint that genuine progress is being made to define clinically useful mechanisms of this treatment, to place it in the context of bipolar disorder pathology, and to move towards a time when the prescription of lithium is targeted to those individuals who will derive the greatest benefit.
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Affiliation(s)
- Benjamin S Pickard
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK.
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36
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37
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Vosahlikova M, Ujcikova H, Chernyavskiy O, Brejchova J, Roubalova L, Alda M, Svoboda P. Effect of therapeutic concentration of lithium on live HEK293 cells; increase of Na + /K + -ATPase, change of overall protein composition and alteration of surface layer of plasma membrane. Biochim Biophys Acta Gen Subj 2017; 1861:1099-1112. [DOI: 10.1016/j.bbagen.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/20/2017] [Accepted: 02/10/2017] [Indexed: 12/19/2022]
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38
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Awdishu L, Mehta RL. The 6R's of drug induced nephrotoxicity. BMC Nephrol 2017; 18:124. [PMID: 28372552 PMCID: PMC5379580 DOI: 10.1186/s12882-017-0536-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/25/2017] [Indexed: 01/05/2023] Open
Abstract
Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney injury, incomplete assessment of concurrent risk factors and lack of long term outcome reporting. Electronic surveillance presents a powerful tool to identify susceptible populations, improve recognition of events and provide decision support on preventative strategies or early intervention in the case of injury. Research in the area of biomarkers for detecting kidney injury and genetic predisposition for this adverse event will enhance detection of injury, identify those susceptible to injury and likely mitigate risk. In this review we will present a 6R framework to identify and mange drug induced kidney injury – risk, recognition, response, renal support, rehabilitation and research.
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Affiliation(s)
- Linda Awdishu
- UC San Diego Skaggs School of Pharmacy, San Diego, USA. .,UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Ravindra L Mehta
- UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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Butler MI, McCartan D, Cooney A, Kelly PO, Ahmed I, Little D, MacHale S, Conlon P. Outcomes of Renal Transplantation in Patients With Bipolar Affective Disorder and Schizophrenia: A National Retrospective Cohort Study. PSYCHOSOMATICS 2017; 58:69-76. [DOI: 10.1016/j.psym.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
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40
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Cheung PW, Nomura N, Nair AV, Pathomthongtaweechai N, Ueberdiek L, Lu HAJ, Brown D, Bouley R. EGF Receptor Inhibition by Erlotinib Increases Aquaporin 2-Mediated Renal Water Reabsorption. J Am Soc Nephrol 2016; 27:3105-3116. [PMID: 27694161 PMCID: PMC5042667 DOI: 10.1681/asn.2015080903] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/28/2016] [Indexed: 01/04/2023] Open
Abstract
Nephrogenic diabetes insipidus (NDI) is caused by impairment of vasopressin (VP) receptor type 2 signaling. Because potential therapies for NDI that target the canonical VP/cAMP/protein kinase A pathway have so far proven ineffective, alternative strategies for modulating aquaporin 2 (AQP2) trafficking have been sought. Successful identification of compounds by our high-throughput chemical screening assay prompted us to determine whether EGF receptor (EGFR) inhibitors stimulate AQP2 trafficking and reduce urine output. Erlotinib, a selective EGFR inhibitor, enhanced AQP2 apical membrane expression in collecting duct principal cells and reduced urine volume by 45% after 5 days of treatment in mice with lithium-induced NDI. Similar to VP, erlotinib increased exocytosis and decreased endocytosis in LLC-PK1 cells, resulting in a significant increase in AQP2 membrane accumulation. Erlotinib increased phosphorylation of AQP2 at Ser-256 and Ser-269 and decreased phosphorylation at Ser-261 in a dose-dependent manner. However, unlike VP, the effect of erlotinib was independent of cAMP, cGMP, and protein kinase A. Conversely, EGF reduced VP-induced AQP2 Ser-256 phosphorylation, suggesting crosstalk between VP and EGF in AQP2 trafficking and a role of EGF in water homeostasis. These results reveal a novel pathway that contributes to the regulation of AQP2-mediated water reabsorption and suggest new potential therapeutic strategies for NDI treatment.
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Affiliation(s)
- Pui W Cheung
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Naohiro Nomura
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anil V Nair
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nutthapoom Pathomthongtaweechai
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lars Ueberdiek
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hua A Jenny Lu
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dennis Brown
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard Bouley
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Zheng P, Lin Y, Wang F, Luo R, Zhang T, Hu S, Feng P, Liang X, Li C, Wang W. 4-PBA improves lithium-induced nephrogenic diabetes insipidus by attenuating ER stress. Am J Physiol Renal Physiol 2016; 311:F763-F776. [PMID: 27385737 DOI: 10.1152/ajprenal.00225.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Endoplasmic reticulum (ER) stress has been implicated in some types of glomerular and tubular disorders. The objectives of this study were to elucidate the role of ER stress in lithium-induced nephrogenic diabetes insipidus (NDI) and to investigate whether attenuation of ER stress by 4-phenylbutyric acid (4-PBA) improves urinary concentrating defect in lithium-treated rats. Wistar rats received lithium (40 mmol/kg food), 4-PBA (320 mg/kg body wt by gavage every day), or no treatment (control) for 2 wk, and they were dehydrated for 24 h before euthanasia. Lithium treatment resulted in increased urine output and decreased urinary osmolality, which was significantly improved by 4-PBA. 4-PBA also prevented reduced protein expression of aquaporin-2 (AQP2), pS256-AQP2, and pS261-AQP2 in the inner medulla of kidneys from lithium-treated rats after 24-h dehydration. Lithium treatment resulted in increased expression of ER stress markers in the inner medulla, which was associated with dilated cisternae and expansion of ER in the inner medullary collecting duct (IMCD) principal cells. Confocal immunofluorescence studies showed colocalization of a molecular chaperone, binding IgG protein (BiP), with AQP2 in principal cells. Immunohistochemistry demonstrated increased intracellular expression of BiP and decreased AQP2 expression in IMCD principal cells of kidneys from lithium-treated rats. 4-PBA attenuated expression of ER stress markers and recovered ER morphology. In IMCD suspensions isolated from lithium-treated rats, 4-PBA incubation was also associated with increased AQP2 expression and ameliorated ER stress. In conclusion, in experimental lithium-induced NDI, 4-PBA improved the urinary concentrating defect and increased AQP2 expression, likely via attenuating ER stress in IMCD principal cells.
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Affiliation(s)
- Peili Zheng
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yu Lin
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Feifei Wang
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Renfei Luo
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Tiezheng Zhang
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shan Hu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Pinning Feng
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; and
| | - Xinling Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunling Li
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weidong Wang
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China;
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42
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Molecular mechanisms in lithium-associated renal disease: a systematic review. Int Urol Nephrol 2016; 48:1843-1853. [DOI: 10.1007/s11255-016-1352-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023]
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Affiliation(s)
- Connie M. Hammond
- Drug Information Consultant Ohio Department of Mental Health Office of Support Services/Pharmacy Service Center Columbus, Ohio 43223 FAX 614/752-0135
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Elie D, Segal M, Low NCP, Mucsi I, Holcroft C, Shulman K, Looper KJ, Rej S. Statins in the prevention of lithium-associated diabetes insipidus: preliminary findings. Kidney Int 2016; 87:862. [PMID: 25826552 DOI: 10.1038/ki.2014.409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dominique Elie
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marilyn Segal
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nancy C P Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Istvan Mucsi
- Division of Nephrology, Department of Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Kenneth Shulman
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Karl J Looper
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Soham Rej
- 1] Department of Psychiatry, McGill University, Montreal, Quebec, Canada [2] Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVE To review the relationship between lithium-related renal dysfunction and microcysts. METHOD Electronic databases (PubMed and Google Scholar) were queried. RESULTS From a total of 12,425 publications, 76 were reviewed. DISCUSSION Glomerular renal dysfunction occurs after an average of 20 years of continuous lithium treatment, and the severity is related to the total lithium load as measured by dose and duration. Recently, several reports have highlighted the relationship between renal microcyst formation and significant reductions in glomerular filtration rate. Radiologically visible lithium-related microcysts are usually 1-2 mm and occasionally 3 mm. Smaller cysts, which are impossible to resolve, are probably more common than the visible cysts, based on observations of renal needle biopsies. Increases in the number of microcysts and the space they occupy within kidney volume appear to be related to both the duration of lithium treatment and the reduction in kidney function. The proposed mechanism of microcyst formation is related to the antiapoptotic effect of lithium. Specifically, by preventing renal tubular epithelial cells from undergoing apoptosis as part of the process of normal renal maintenance, lithium may be allowing the inappropriate growth of the surface area of tubules to form invaginations and ultimately cysts. It is proposed that the physical space occupied by these cysts in the limited volume within the renal capsule compromises the function of otherwise healthy renal tissue. Monitoring of kidneys utilizing radiographic imaging may be more sensitive than monitoring laboratory values. Additional research is required to optimize this new monitoring tool.
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Affiliation(s)
- Mashal Khan
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, KY, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, KY, USA
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Bulteau S, Vigneau C, Bronnec M, Etcheverrigaray F, Maulaz B, Guitteny M, Masson M, Vanelle JM, Sauvaget A. Modalités de surveillance des sels de lithium en psychiatrie : des guidelines à la pratique. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2015.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Antihypertensive therapy in patients on chronic lithium treatment for bipolar disorders. J Hypertens 2016; 34:20-8. [DOI: 10.1097/hjh.0000000000000758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Sands JM. Water, Water Everywhere: A New Cause and a New Treatment for Nephrogenic Diabetes Insipidus. J Am Soc Nephrol 2015; 27:1872-4. [PMID: 26712528 DOI: 10.1681/asn.2015111223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jeff M Sands
- Renal Division, Department of Medicine and Department of Physiology, Emory University School of Medicine, Atlanta, Georgia
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Wood CG, Stromberg LJ, Harmath CB, Horowitz JM, Feng C, Hammond NA, Casalino DD, Goodhartz LA, Miller FH, Nikolaidis P. CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics 2015; 35:125-41. [PMID: 25590393 DOI: 10.1148/rg.351130016] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cystic renal lesions are commonly encountered in abdominal imaging. Although most cystic renal lesions are benign simple cysts, complex renal cysts, infectious cystic renal disease, and multifocal cystic renal disease are also common phenomena. The Bosniak classification system provides a useful means of categorizing cystic renal lesions but places less emphasis on their underlying pathophysiology. Cystic renal diseases can be categorized as focal, multifocal, or infectious lesions. Diseases that manifest with focal lesions, such as cystic renal cell carcinoma, mixed epithelial and stromal tumor, and cystic nephroma, are often difficult to differentiate but have differing implications for follow-up after resection. Multifocal cystic renal lesions can be categorized as acquired or heritable. Acquired entities, such as glomerulocystic kidney disease, lithium-induced nephrotoxicity, acquired cystic kidney disease, multicystic dysplastic kidney, and localized cystic renal disease, often have distinct imaging and clinical features that allow definitive diagnosis. Heritable diseases, such as autosomal dominant polycystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis, are usually easily identified and have various implications for patient management. Infectious diseases have varied imaging appearances, and the possibility of infection must not be overlooked when assessing a cystic renal lesion. A thorough understanding of the spectrum of cystic renal disease will allow the radiologist to make a more specific diagnosis and provide the clinician with optimal recommendations for further diagnostic testing and follow-up imaging.
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Affiliation(s)
- Cecil G Wood
- From the Department of Radiology, Northwestern Memorial Hospital, 676 N Saint Clair St, Suite 800, Chicago, IL 60611
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