Lithium nephrotoxicity develops in patients treated long term with lithium. About 40% of patients receiving lithium may develop nephrogenic diabetes insipidus. End-stage kidney disease occurs in about 1.5% of long-term lithium users, usually after greater than 15 years of drug exposure. Patients are typically middle aged and most are white; there are no sex differences. Patients typically have low-level proteinuria, with a quarter showing nephrotic-range proteinuria. GFR loss is slowly progressive.