RESISTANT (Now Stable) BPAD WITH RAISED CREATININE ISSUE

One of my patients of Resistant BPAD, I made him mentally stable now through my treatment. But now my only concern is that he has always elevated CREATININE level like 1.8 or 1.9 mg/dl, while normal range is 0.7-1.4 mg/dl. I told him to drink a lot of water & he also takes about 3-4 litres of water/day. Then also, always I get ELEVATED CREATININE. Though his urea level always comes normal. I am sharing the report. He is a patient of BPAD, along with hyperglycemia (Now controlled with Metformin 500mg), Hypothyroidism (Now controlled with Eltroxin 50mcg). I am keeping him on Lithium 900mg in divided doses & Clozapine 300mg in divided doses. He is Euthymic now. Any opinion about ELEVATED CREATININE ONLY & NORMAL urea level from last 4-5 months........Thanks!!

(Edited)

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Urea levels are dependent on metabolism of exogenous protein like food. Likely to be variable, depending on type of food. S . Crameatinine depends on endogenous protein metabolism.. So , S Creatinine levels are better reflection of renal status. Need to further assess renal function with Urine Protein Creatine Ratio., abdominal ultrasound. Patient is also likely to have Diabetic Nephropathy. Both lithium and clozapine are nephrotoxic, especially, related to the duration of intake. Suggest consult Nephroligist and consider risk : benefit ratio of continued use of these drugs.

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Euthymic state is not so bad if he does his work properly though it can be easily noticed. Though I have not used but these two drugs dicrease the secretion of creatinine, one is antibiotic trimethoprime sulphamethoxazole & the H2-blocker cimetidine. Better to take opinion of a nephrologist also.

Thank you doctor
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I can assess the risk:benefit ratio. But the patient was suffering with worst kind of BPAD, with severe violent episodes. I am treating him from last 1 year, & after lot of labour, I have made him stable & euthymic. Now, when patient is totally controlled, I am facing this SERUM CREATININE issue. All other parameters are WITHIN NORMAL LIMITS. Patient is doing very well now. So, I can take nephrology opinion, how much elevated creatinine is of concern? Also I am going for eGFR & USG Lower Andomen.

Patient have long time history....renal creatinine level abnormal should be tapped tablet lithium drug...and physician reference for renal function impaired and prefer other drugs like aripriprazole.. Trifluoperazine...

Consult NEPHROLOGIST.

I am actually wanting Nephro opinion only at this platform.
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Sir, it's better to calculate eGFR in some cases so that we will get accurate measure of kidney function

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Raised creatinine may be due to lithium .....metformin should be stopped

Stop lithium

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