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Table 1 Risk factors for lithium induced nephropathy and their proposed mechanisms

From: Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification

Risk Factor Proposed Mechanism
Duration of lithium therapy Prolonged lithium exposure leading to irreversible structural changes within the kidney parenchyma
Age Age related decline in eGFR, polypharmacy, medical comorbidity
Lower initial eGFR Reduced nephron mass, background tubulointerstitial damage
Female gender Unclear mechanism
Cumulative lithium dose Prolonged lithium exposure leading to irreversible structural changes within the kidney parenchyma
Other concomitant CKD risks (hypertension, diabetes mellitus) Concomitant tubulointerstitial damage, nephrosclerosis
Concomitant use of nephrotoxic medications Disruption of tubulo-glomerular feedback, volume contraction, drug-interactions
Prior episodes of lithium toxicity Higher lithium concentrations, induction of acute kidney injury with subsequent chronic damage
NDI Volume contraction leading to elevated lithium concentrations, may be surrogate marker for morphological changes occurring within the kidney tubules