What causes excessive thirst and frequent urination?

Question

Hello doctor,

I have been on Lithium for bipolar disorder for over 20 years. From a blood test two years ago, I noticed that my GFR was below 40. So, I gradually started switching from Lithium to Epilim to avoid further damage to my kidneys. But now, I experience excessive thirst and I wake up at night to pee and drink more. I have transparent urine with bubbles, and I also feel quite tired. I would like to know what are your suggestions for these issues. Please find attached my blood and urine results chronologically ordered from the last two years. At the end of this month, I will do a kidney scan but, I have not seen a nephrologist until now.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen your detailed reports (attachment removed to protect patient identity).

Lithium commonly causes two types of renal disease, namely nephrogenic diabetes insipidus and chronic tubulointerstitial nephritis.
Diabetes insipidus is causing the symptoms of increased thirst and polyuria in your case. Check your ADH (anti diuretic hormone) level to confirm the diagnosis. Thiazide diuretic will help reduce your symptoms.
Tubulointerstitial nephritis is causing the reduced eGFR (estimated glomerular filtration rate) and the raised creatinine levels. Do a renal ultrasound, 24-hour urine protein, and sodium level.

Revert with the above reports. We can decide the further steps based on that.