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Republished: Partial nephrogenic diabetes insipidus associated with lithium therapy
  1. Eka Nandoshvili1,
  2. Steve Hyer1,
  3. Nikhil Johri2
  1. 1 Endocrinology, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Carshalton,UK
  2. 2 Chemical Pathology, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Carshalton, UK
  1. Correspondence to Steve Hyer; steve.hyer{at}nhs.net

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Summary

A 40-year-old Caucasian man developed excessive thirst and polyuria particularly at night over the preceding 6 months. He had been taking lithium for 16 years for the treatment of bipolar affective disorder. Investigations revealed subnormal maximum urinary concentrating ability after 8 hours of water deprivation and only a borderline response of urine osmolality to exogenous desmopressin given by intramuscular injection. A plasma copeptin concentration was elevated at 23 pmol/L. These results were consistent with partial nephrogenic diabetes insipidus. He was encouraged to increase his water intake as dictated by his thirst. In addition, he received amiloride with some improvement in his symptoms. Clinicians should be aware of the risk of nephrogenic diabetes insipidus with long-term lithium use and seek confirmation by a supervised water deprivation test augmented with a baseline plasma copeptin. If increased water intake is insufficient to control symptoms, amiloride may be considered.

Background

Lithium is widely used in the treatment of depression and bipolar disorder. In chronic use, lithium accumulates in the distal tubular cells of the kidneys producing a defect in their concentrating ability. This is manifest as partial or full nephrogenic diabetes insipidus (NDI). The diagnosis is confirmed by elevated levels of circulating arginine vasopressin (AVP). More recently, measurement of plasma copeptin, the C-terminal glycoprotein moiety of the AVP prohormone, has been shown to offer advantages over measuring circulating AVP and can reliably discriminate between central and nephrogenic diabetes insipidus (DI). We report a patient with partial NDI associated with chronic lithium …

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