Renal Function during Lithium Treatment

Renal function tests were performed in 101 unselected patientswho had been on lithium for two weeks to 12 years. None hada recorded episode of lithium intoxication. The glomerular filtration rate (GFR), was not correlated withthe cumulative dose of lithium or the duration of use of otherpsychotropic drugs. Nine patients had creatinine clearanceslower than predicted; in six of these, no cause was identifiedand the small reductions in GFR may have been related to lithiumuse. Urinary concentrating ability (U_max) declined with age, andtotal dose of lithium received. Although the concurrent useof neuroleptics did not significantly reduce the U_max the totalduration of treatment with these drugs showed a negative correlation.The results suggest that prolonged use of neuroleptics, particularlyin patients treated with lithium, may be responsible for anirreversible reduction in urine concentrating ability. Microalbuminuria was present in 40 per cent of the patients,although the rate of albumin excretion was not correlated withduration of use of psychotropic drugs. ß₂ microglobulinexcretion was only raised in nine of these patients, suggestingthat increased glomerular permea bility rather than impairedproximal tubular protein reabsorption was responsible for theproteinuria. The urinary excretion of ß₂ microglobulin and N-acetyl-ß-glucosaminidasewere slightly in creased in small numbers of patients, indicatinglittle evidence for proximal tubular damage. In creased NAGexcretion did not correlate with reduced distal tubular function.However, there was a tendency to higher urinary ß₂microglobulin excretion in patients with a reduced U_max     

POST-KALA-AZAR DERMAL LEISHMANIASIS: A CLINICAL AND THERAPEUTIC STUDY

Background. Post-kala-azar dermal leishmaniasis is a condition peculiarly confined to the Indian subcontinent. Methods. The clinical features and investigations in 18 patients of post-kala-azar dermal leishmaniasis were studied. Results. There was a polymorphic picture from hypopigmented macules to nodules and plaques. Mucous membranes were affected in five, the lips and glans penis being the most frequent sites, Histopathologically, a rich dermal infiltrate was seen in indurated lesions and in macules; it was confined to perivascular foci in the upper dermis. Leishman-Donovan bodies were seen in 16. Conclusions. The lesions cleared in 4 to 5 months after treatment with sodium antimony gluconate intramuscularly 20 mg/kg/day up to a maximum of 1 g/day. The drug was well tolerated.