RT Journal Article SR Electronic T1 Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e242841 DO 10.1136/bcr-2021-242841 VO 14 IS 7 A1 Sam Topp A1 Emma Salisbury YR 2021 UL http://casereports.bmj.com/content/14/7/e242841.abstract AB Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.