Lithium and Embracing Chronic Kidney Disease

[Inanlae]

I'm going to see my pdoc today.  Recently, we've determined I need to stop taking lithium because it's rapidly depressing my kidney function values.  (My quality of life, related to my kidneys, does not seem to be affected at this point.  It is only my serum levels that were off, and they rebounded with the removal of lithium.)  

Since, I've tried Trileptal.  I quit that soon after starting it, as I began a painful depression with acute agitation, which I would consider a mixed state, and one of the more dangerous instantiations of my bipolar disorder, where I begin to see things around me as objects with which to harm myself, and coupled with a desire to do something with them, as opposed to mere depression, which tends to be merely cerebral.  

 

Yesterday morning, I ceased Tripleptal and commenced Depakote.  There is no noticeable therapeutic benefit as of yet.  I am still experiencing a very painful depression.  I am taking a non-extended release Wellbutrin, which abates the pain somewhat, but when it wears off, drops me very hard.  My pdoc doesn't want me to take this at all as it is essentially mood destabilizing.  She gets upset when I take very much, as she says this can cause seizures, forgetting that I am taking it for symptomatic reasons, and not for the purpose of irritating her.

One of my medications may be causing a low platelet count, I don't remember which of them this was supposed to have correlated with.  I'll probably ask for a CBC today.  I have a HUGE bruise on my hip from falling down the stairs in a rather thereapeutic attempt at self-medication with alcohol during the Trileptal stage of this week.  The bruise was perhaps exacerbated by the blood-thinning property of that therapy.  

I've missed work all week.  (In my experience, going out anywhere when symptomatic is a terrible idea, and especially anywhere where there's a lot at stake.  I've lost more than one job this way, and am fortunate to have FMLA benefits at present.)

I only want twenty to thirty good years.  I don't need to live forever.  I want to outlive my parents.  I want to see my siblings happy.  I want to pay off my debts.  And I want to make a positive contribution to human well-being.  What is the prognosis for renal health if I return to a therapeutic dose of lithium?  Has anyone chosen to do this?  I know she's going to be pissed off when I ask this question later. Should I ask a nephrologist perhaps?  Is it likely that a person in that specialty has ever fielded this question before?  Perhaps my pdoc will refer me for a consultation.  I doubt I could piss her off more than I already have.  She prefers to criticize my weight loss, as if the weight of a corpse were ever of a matter of great import.  

If I have to choose between the two organs, I would rather choose my brain.  The thing that perhaps bothers me most about sacrificing my kidneys is that I might be choosing now to put myself ahead of someone else perhaps on a transplant list someday, should I want to stay alive longer....  I have it now in my power to prevent that.  And I don't like knowingly compromising the quality of my organs should circumstances require them for donation, though with my therapeutic use of alcohol I'm hardly cultivating a prize liver.

So, has anyone out there chosen lithium and chronic kidney disease, or know of someone who has, and have any idea of the prognosis of CKD in the presence of Li?

Thank you.



 

Edited August 7, 2014 by Inanlae

[Inanlae]

Though a urologist does treat the kidneys, a nephrologist specializes in the kidneys and only the kidneys.  I bet either could field my question.  I'll probably ask for a referall today.  Thanks!

[Will]

I think seeing a specialist is a wonderful idea.  I quit lithium because it had stopped working (I think) plus a high creatinine level.  But, there is reason to believe that even if lithium is not right for you that other mood stabilizers would work for you.

[Inanlae]

Thanks, Will, that's not very heartening, though true.  Have you found another mood stabilizer that works for you, and if so, what is it?

[Will]

I am trying lamictal.  Whether it works is unclear.  I had a recent hospitalization but I  was under a lot of work stress and may not have been at proper level .    I cannot give up hope and will keep trying.  Whatever you do, please do not give up.

[dpshaw]

Inanlae, you've got me concerned now. I've only been on lithium for about a year and a half. How long does it take for chronic kidney disease to set in? Or is it a 'your mileage may vary' type thing? Also, how do you know when your kidneys start going or is it obvious? I currently have no plans to quit lithium.

[dpshaw]

Thanks, Sylvan! That's reassuring. Sorry to hear about your kidney stone. I do get blood work done every few months (next time: this Monday). So, I'll stop stressing and trust my pdoc.

And my apologies to the OP for briefly hijacking the thread.

[Inanlae]

Sylvan, your GP sounds AWESOME!  I'm still on the hunt for some like her!  I'm sorry to hear that your team's so large, and especially that you have an oncology contingent.

Will, I hope Lamictal works for you!  I was allergic to it.  I won't give up.  Don't you give up, either.  Thanks for the encouragement!

 

DP & Sylvan, I was on it over 7 years before my kidney levels were off.  Sylvan, I think the other kidney analyte you're thinking of is blood urea nitrogen (BUN).  As Sylvan says, many people never have kidney problems due to lithium.  My pdoc told me today I might be able to get back on it with only mildly abnormal kidney function results, so I don't think the situation is as dire as I had originally thought.  I really <3 lithium.  It gave me a lot of my life back.  I hope this isn't goodbye forever.  But for now, I'm giving Depakote a go.

[Inanlae]

Any feedback I can get on the lithium withdrawal would be appreciated.  Thanks.

Perhaps you'd like to start a new thread under that "anticonvulsants/mood stabilizers" forum category, titled something like "lithium withdrawal"?  Perhaps it will attract more attention about withdrawal, even from people who haven't had kidney issues.  I would benefit from this as well.  I'm struggling with getting off lithium--digging my heels in at 150 mg lithium.  It's probably good that you're still on your antidpressant, as that will give you some continuity.  My pdoc told me I might be able to stay on my lithium if my abnormal kidney function improves (definitely above stage III levels, though).  Definitely make this decision with your pdoc, not just your nephro.  Please feel free to post back how it's going.  The Wikipedia page posts GFR (glomelar filtration rates) which correlate with various stages of chronic kidney disease (CKD).  From what I've read elsewhere, though, you have to have values at a particular level for several weeks before a diagnosis of that stage of CKD can be made.  I had one set of labs that supported CKD, stage III, but reducing lithium resulted in a return to normal kidney function values. 

[crtclms]

My kidney values were already too high when I started lithium because of permanent damage done by zonegran. The kidney disease zonegran gave me is renal tubular acidosis, and it makes you make stones at a ridiculous rate. Both my "pdoc" and my urologist have been totally relaxed about my staying on the lithium. My values have crept up a bit, but I was just hospitalized for a septic kidney infection last November, and I'm guessing that played a role.

 

I really like lithium, I'm sorry you have to give it up, OP.

[december_brigette]

I LOVED LITHIUM. I was on it for many years. It's hard for me to count right now because I went off during my pregnancy. maybe a total of 6 or 7 yrs?

 

Anyway...I started peeing black. Pdoc immediately withdrew me from lithium. I think we waited a few days. Then I started depakote. i like depakote the same as Iiked lithium, thank god.

 

I guess Im not willing (nor is my pdoc) to give up an organ in its entirety. I did go to a nephrologist. He did some testing and ultrasounds. But I guess I was lucky and there was not much damage. I don't remember all my numbers, sorry.

 

Take care of yourselves,

db