Document Detail

Distal nephron function in patients receiving chronic lithium therapy.
MedLine Citation:
PMID:  6283233     Owner:  NLM     Status:  MEDLINE    
Renal tubular function was studied in 14 patients chronically treated with lithium for affective disorders. Patients were separated into two groups according to the duration of lithium therapy: long-term (35 +/- 7.0 months) and short-term (4.8 +/- 0.8 months). At comparable urine lithium concentrations, patients on long-term therapy had a lower maximal urine osmolality (Umax) and free water reabsorption (TcH2O) than did patients on short-term therapy. The latter group achieved a Umax above 800 mOsm kg H2O. In contrast, both groups of patients failed to increase the urine-blood (U-B) Pco2 gradient normally during acute sodium bicarbonate loading. This low U-B Pco2 was observed at comparable urine bicarbonate concentrations between both groups of patients and controls, and thus was associated with a higher urine pH in patients. These findings indicate that the inability of these patients to achieve a normal U-B Pco2 in a maximally alkaline urine was the result of decreased distal hydrogen ion secretion rather than inability to raise urine bicarbonate concentrations as a result of a concentrating defect. Bicarbonate reabsorptive capacity was normal in our lithium-treated subjects. Both groups of patients achieved a normal U-B Pco2 gradient in response to sodium phosphate loading. They also were able to achieve a minimal urine pH and a maximal acid excretion similar to those of controls in response to a 3-day ammonium chloride loading test. Our data demonstrate that chronic lithium therapy is associated with a mild distal acidification defect disclosed only by the finding of a low U-B Pco2 gradient during sodium bicarbonate loading. This peculiar defect can be found in short-term lithium-treated patients in whom the concentrating capacity is relatively well preserved.
D Batlle; M Gaviria; M Grupp; J A Arruda; J Wynn; N A Kurtzman
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Kidney international     Volume:  21     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  1982 Mar 
Date Detail:
Created Date:  1982-08-14     Completed Date:  1982-08-14     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  GERMANY, WEST    
Other Details:
Languages:  eng     Pagination:  477-85     Citation Subset:  IM    
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MeSH Terms
Ammonium Chloride / pharmacology
Bicarbonates / pharmacology,  urine
Carbon Dioxide / urine
Glomerular Filtration Rate
Hydrogen-Ion Concentration
Kidney Tubules / physiology*
Kidney Tubules, Distal / physiology*
Lithium / pharmacology*,  therapeutic use*
Osmolar Concentration
Sodium Bicarbonate
Water / physiology
Water Deprivation
Grant Support
Reg. No./Substance:
0/Bicarbonates; 12125-02-9/Ammonium Chloride; 124-38-9/Carbon Dioxide; 144-55-8/Sodium Bicarbonate; 7439-93-2/Lithium; 7732-18-5/Water

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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