Serum Lithium (Li) Values within Recommended Range May Induce Changes in Renal Tubular Function and Calcium Homeostasis in Patients with Bipolar Disorder (BD)
November 02, 2017 | 10:00 AM - 10:00 AM
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Abstract: TH-PO1052
Serum Lithium (Li) Values within Recommended Range May Induce Changes in Renal Tubular Function and Calcium Homeostasis in Patients with Bipolar Disorder (BD)
Session Information
Category: Mineral Disease
- 1201 Mineral Disease: Ca/Mg/PO4
Authors
- Hortêncio, Lucas De oliveira serra, Institute of Psychiatry of University of Sao Paulo, Sao Paulo, Brazil
Lucas De oliveira serra Hortêncio,
- DE ALMEIDA, Karla M, Institute of Psychiatry of University of Sao Paulo, Sao Paulo, Brazil
- Silva, Michelle, Institute of Psychiatry of University of Sao Paulo, Sao Paulo, Brazil
- Lafer, Beny, Institute of Psychiatry of University of Sao Paulo, Sao Paulo, Brazil
- Helou, Claudia, Lab Pesquisa Basica LIM12 Fac Medicina Univ Sao Paulo, SP, Brazil, Sao Paulo, Brazil
Background
Li is the first choice for maintenance treatment of patients with BD. However, Li can induce nephrogenic insipidus diabetes and some patients may develop asymptomatic hypercalcemia because Li may cause primary hyperparathyroidism.
Methods
Thus, we studied 76 patients with BD treated with or without Li by a cross-sectional analysis. We collected blood (B) and 24-hour urine (U) samples to evaluate renal function, electrolyte homeostasis and serum (S) hormone levels.
Results
As shown in the Table, we studied more women than men, but they had similar age, eGFR, and S Li values were within recommended range. Both women and men treated with Li had higher U pH and lower U density than Non-Li-treated patients. Li-treated-women had also higher levels of S PTH, S ionized Ca (S iCa) than that of other groups. Moreover, Li-treated-women showed a positive correlation between high levels of S iCa and increases of S PTH, diuresis and U pH and low U density when we plotted levels of S iCa≥5.47 mg/dL. On the other hand, only Non-Li-treated women showed low levels of S PTH, diuresis and U pH and high U density when we plotted levels of S iCa≤4.88 mg/dl. No patient showed any symptom and other ionic homeostasis disorder.
Conclusion
Li induced changes in both parathyroid and renal tubular function without clinical manifestations justifying a periodically monitored surveillance especially in women patients.
| | WOMEN | MEN |
| | Li | Non-Li | Li | Non-Li |
| n | 20 | 32 | 17 | 7 |
| Age, years | 45±2 | 45±2 | 45±2 | 49±5 |
| eGFR, ml/min | 91±5 | 97±3 | 92±5 | 101±3 |
| S Li, mEq/l | 0.71±0.05 | | 0.66±0.05 | |
| S iCa, mg/dl | 5.25±0.07*** | 4.96±0.03 | 5.07±0.05 | 5.03±0.09 |
| S PTH, pg/ml | 58±7* | 42±3 | 46±3 | 44±4 |
| 25 OH vitamin D, ng/ml | 18±2 | 19±2 | 18±1 | 19±2 |
| Free T4, ng/dl | 1.14±0.04 | 1.15±0.04 | 1.22±0.05 | 1.14±0.04 |
| U output, ml/day | 1998±228 | 1469±105 | 2388±303 | 1430±170 |
| U pH | 6.73±0.18*## | 6.10±0.16 | 6.44±0.17# | 5.50±0.33 |
| U density | 1010±1**### | 1017±1## | 1013±1## | 1025±2 |
| UV Ca, mg/day | 138±15 | 141±22 | 189±55 | 162±45 |
eGFR, estimated glomerular filtration rate calculated by CKD-EPI formula. *P<0.05, **P<0.01, ***P<0.001 vs Non-Li-treated women; #P<0.05, ##P<0.01,###P<0.001 vs Non-Li-treated men derived from ANOVA followed by Newman-Keuls test
Funding
- Government Support - Non-U.S.