Janos Rado. Renal toxicity of lithium in historical perspective with special reference to nephrogenic diabetes insipidus and its treatment.

Janos Radó’s reply to Janusz Rybakowski’s commentary

        Many thanks to Professor Rybakowski for his comment, which is as comprehensive as a comment could be. We are grateful for the perfect evaluation of the clinical significances of the different lithium-induced renal abnormalities.

        Professor Rybakowski stresses that the most important kidney side effect is lithium-nephropathy resulting in renal failure and makes a real case for termination of lithium therapy. It is sometimes a tragic event for the excellent responding long-term treated patient because of the high risk to relapse.

        We have to congratulate the Rybakowski Group for their wise recommendations in lithium therapy (lowering plasma lithium levels, more intensive role of nephrologists, etc.) by which they are able to continue lithium treatment (in  their  excellent responding patients) even with lithium-induced nephropathy.

        However, our field is lithium-induced permanent nephrogenic diabetes insipidus and other associated abnormalities. In such a patient with advanced lithium-induced renal tubular acidosis severe metabolic bone disease also developed (Radó 2018). Bone pain could not be easily eliminated. Calcitonin was administered with a surprising result. The antidiuretic action of desmopressin was abolished and the polyuria was restored. It is interesting that a basically (probably) antidiuretic molecule behaved as a “diuretic.” We proposed the possibility of a competitive antagonism between desmopressin and calcitonin (Radó  2018)

        By the way, I read recently with great enthusiasm Professor Rybakowski’s  excellent 2018 review article on Challenging the negative perception of lithium and optimizing its long term administration. The significance of this work is characterized by a remark of Domenico De Berardis at the end of the publication: “The underutilization of lithium is a plague and …malpractice. Your paper should be read by all psychiatrists and residents.”

        I appreciate very deeply  Professor Rybakowski’s commentary on my “Review of the literature” (Radó  2019).

References:

Radó J. Final comment (Use of modern antidiuretic agents in the treatment of permanent lithium-induced nephrogenic diabetes insipidus [Barry Blackwell: The lithium controversy. A historical autopsy]). inhn.org.collated. January 25, 2018.

Radó J. Addition to final comment: Calcitonin in lithium-induced nephrogenic diabetes insipidus (Barry Blackwell: The lithium controversy. A historical autopsy) inhn.org.collated.  September 13, 2018.

Radó J. Renal Toxicity of Lithium in Historical Perspective with Special Reference To Nephrogenic Diabetes Insipidus and its Treatment. inhn.org.controversies. May 2, 2019.

Radó J. Desmopressin may counteract polyuria in lithium-induced nephrogenic diabetes insipidus (Review of the literature). inhn.org.archives. July 18, 2019.

Rybakowski J. Challenging the negative perception of lithium and optimizing its long term administration. Frontiers in Molecular Neuroscience. October 2018.

June 27, 2019