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Lithium is a useful treatment for bipolar disorder; it attenuates the recurrence of affective episodes and reduces the risk of suicide among bipolar patients. Nevertheless, lithium has a plethora of side effects some of which are serious and may be irreversible. Among the most troubling side effects of lithium is its nephrotoxicity. Herein we report a case of a bipolar patient who developed signs of lithium-induced nephrotoxicity including overt polyuria after 18 years of lithium treatment. Due to concerns that his renal function will continue to deteriorate, two trials to switch him to other psychotropic drugs were done following which he committed two aggressive suicidal attempts. As a result, a joint decision was reached between the patient, his family, psychiatrist and nephrologist that lithium is a “life-saving” treatment for him and lithium was never stopped again. To date, at 68 years old and after nearly 40 years of lithium treatment the patient is mentally stable and reasonably functional. His kidney function continued to deteriorate slowly through the years and he is now a candidate for hemodialysis. This case report emphasizes the need to balance between concerns regarding the damage to the kidney which is a result of long-term lithium treatment to the significant therapeutic benefit of lithium as a mood stabilizer and anti-suicidal drug.

Lithium-induced Nephrogenic Diabetes Insipidus–A Case Report and Discussion on the Pathophysiological Mechanism