skip to main content

Lithium and Renal Function — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMood DisordersLithium and Renal FunctionMRCPsych Paper B

A 42-year-old man with bipolar I disorder has remained well on lithium for 8 years. His eGFR has fallen progressively over serial measurements and is now 45 mL/min/1.73 m². When considering whether lithium should be continued, whose advice should be sought if specialist input is needed, according to NICE CG185?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — A renal specialist and a clinician with expertise in managing bipolar disorder

The correct answer is E. NICE advises that a fall in eGFR over two or more tests should prompt more frequent monitoring of lithium levels and renal function, including assessment of the rate of deterioration. When deciding whether to continue lithium, clinicians should consider its clinical efficacy, the degree of renal impairment, and other renal and cardiovascular risk factors. If specialist advice is needed, this should come from both a renal specialist and a clinician experienced in managing bipolar disorder. Renal impairment does not automatically require lithium discontinuation, because stopping an effective treatment may increase relapse risk. Cardiology may be relevant to cardiovascular comorbidity but does not replace renal assessment; endocrinology and neurology are not the indicated specialties for this decision.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), recommendations 1.10.22–1.10.23. Published 2014; updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations