20.500.12556/DiRROS-31368 Lithium in bipolar disorder renal mechanisms, nephrotoxicity phenotypes, and a shared-care pathway for clinical practice Lithium remains a cornerstone mood stabilizer for bipolar disorder, with strong evidence for relapse prevention and a unique association with reduced suicide risk. Its benefit is counterbalanced by renal adverse effects, ranging from impaired urinary concentrating capacity and nephrogenic diabetes insipidus (NDI) to chronic tubulointerstitial nephropathy with progressive loss of glomerular filtration rate in a minority of long-term users. Mechanistically, lithium enters collecting duct principal cells via the epithelial sodium channel, disrupts vasopressin-regulated water handling by downregulating aquaporin-2, and can drive chronic interstitial injury. Risk is amplified by episodes of lithium intoxication, dehydration, interacting medications that reduce renal lithium clearance, longer treatment duration, and comorbid kidney disease. This review integrates psychiatric and nephrologic perspectives on lithium’s indications, mechanisms, renal phenotypes, and prevention strategies, and proposes a practical shared-care pathway for patients with bipolar disorder who develop polyuria, NDI, acute kidney injury, or chronic kidney disease during lithium therapy, emphasizing monitoring, targeted treatment of polyuria, mitigation of toxicity, and structured shared decision-making when renal function declines. lithium bipolar disorder chronic kidney disease diabetes insipidus litij bipolarna motnja kronična ledvična bolezen diabetes insipidus true false true Angleški jezik Slovenski jezik Neznano 2026-07-30 09:48:29 2026-07-30 09:48:29 2026-07-31 03:55:26 0000-00-00 00:00:00 2026 0 0 Nasl. z nasl. zaslona; Opis vira z dne 30. 7. 2026; str. 1-18 issue 15, [article no.] 6730 Vol. 27 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.89 1422-0067 10.3390/ijms27156730 286415107 RAZ_Rijavec_Nikolina_2026.pdf RAZ_Rijavec_Nikolina_2026.pdf 1 1154925B6B0DAEC635DC5254D907027F 3b5c2f981a5b4ecad1c6a579d1fcc1d0396dceaac5cc891d14cb1a7166e808f7 265a4e77-8beb-11f1-923b-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=48548 https://www.mdpi.com/1422-0067/27/15/6730 1 0fb76e1c-8beb-11f1-923b-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=48547 Univerzitetni klinični center Ljubljana 0 0 0