Long-term lithium treatment in bipolar disorder: effects on glomerular filtration rate and other metabolic parameters

Background: Concerns about potential adverse effects of long-term exposure to lithium as a mood-stabilizing treatment notably include altered renal function. However, the incidence of severe renal dysfunction; rate of decline over time; effects of lithium dose, serum concentration, and duration of treatment; relative effects of lithium exposure vs. aging; and contributions of sex and other factors all remain unclear. Methods: Accordingly, we acquired data from 12 collaborating international sites and 312 bipolar disorder patients (6142 person-years, 2669 assays) treated with lithium carbonate for 8–48 (mean 18) years and aged 20–89 (mean 56) years. We evaluated changes of estimated glomerular filtration rate (eGFR) as well as serum creatinine, urea–nitrogen, and glucose concentrations, white blood cell count, and body-mass index, and tested associations of eGFR with selected factors, using standard bivariate contrasts and regression modeling. Results: Overall, 29.5% of subjects experienced at least one low value of eGFR ( 55; risk of ≥2 low values was 18.1%; none experienced end-stage renal failure. eGFR declined by 0.71%/year of age and 0.92%/year of treatment, both by 19% more among women than men. Mean serum creatinine increased from 0.87 to 1.17 mg/dL, BUN from 23.7 to 33.1 mg/dL, glucose from 88 to 122 mg/dL, and BMI from 25.9 to 26.6 kg/m2. By multivariate regression, risk factors for declining eGFR ranked: longer lithium treatment, lower lithium dose, higher serum lithium concentration, older age, and medical comorbidity. Later low eGFR was also predicted by lower initial eGFR, and starting lithium at age ≥ 40 years. Limitations Control data for age-matched subjects not exposed to lithium were lacking. Conclusions: Long-term lithium treatment was associated with gradual decline of renal functioning (eGFR) by about 30% more than that was associated with aging alone. Risk of subnormal eGFR was from 18.1% (≥2 low values) to 29.5% (≥1 low value), requiring about 30 years of exposure. Additional risk factors for low eGFR were higher serum lithium level, longer lithium treatment, lower initial eGFR, and medical comorbidity, as well as older age

The high-resolution stereo camera (HRSC) experiment on Mars Express: Instrument aspects and experiment conduct from interplanetary cruise through nominal mission

ESA's Mars Express has successfully completed its nominal mission of one Martian year covering about 25% of the surface in stereo and color with resolutions up to 10 m/pixel by its high-resolution stereo camera (HRSC). Mars Express is now in its extended mission phase, during which much of the remaining part of the Martian surface is envisaged to be covered in stereo and color. The HRSC instrument is designed to map the morphology, topography, structure and geologic context of the surface as well as atmospheric phenomena. This paper discusses the measurement principles and operations of the instrument as well as the acquisition, calibration and processing of regional and global data sets. As HRSC is a push-broom scanning instrument with nine CCD line detectors mounted in parallel on a focal plane, its unique feature is the ability to obtain near-simultaneous imaging data at high resolution, with along-track triple stereo, four colors and five different phase angles, avoiding any time-dependent variations of the observing conditions. The HRSC spatial resolution is 10 m/pixel at the nominal periapsis altitude of 250 km, with an image swath of 53 km, and 2.3 m/pixel for an additional framing CCD device, called super resolution channel (SRC), practically working as an additional tenth channel of the HRSC and yielding nested-in black and white images for studies of small-scale geologic features. The sub-pixel accuracy of the three-dimensional point determination allows the derivation of digital terrain models (DTMs) with a grid size of up to 50 m and a height accuracy of a single pixel with up to 10 m, thus enabling us to carry out detailed quantitative analyses of the surface structure. The HRSC (1) bridges the gap between the medium–high-resolution Viking imagery and the very-high-resolution Global Surveyor mission, thus providing geological context, and (2) fills the gaps in the three-dimensional coverage and DTM grid of the MOLA laser altimetry data, and (3) helps characterize landing sites for in-situ measurements. HRSC also builds the basis for extended compositional mapping when combining spectral information with topographic photomaps over large areas. So far the HRSC measurements have made a significant contribution to the study of the evolution of volcanism and the role of water and ice throughout the Martian history