Comparison between Carprofen and Meloxicam for Post-Neutering Pain Management in Pet Rabbits.

Surgical neutering in pet rabbits is common practice to prevent reproduction and associated health issues. Adequate postoperative pain management is crucial for recovery, yet effective methods in clinical settings remain underexplored. This study compared the analgesic effects of carprofen and meloxicam in pet rabbits undergoing surgical neutering. Fifty rabbits of varied demographics were included, with pain assessed using the Centro Animali Non Convenzionali Rabbit Scale (CANCRS). Rabbits were allocated to receive postoperative 2 mg kg-1 carprofen or 1 mg kg-1 meloxicam by subcutaneous injection. Anesthesia was induced with an intramuscular combination of ketamine (20 mg kg-1), medetomidine (0.4 mg kg-1), and butorphanol (0.2 mg kg-1), and ovariectomy or orchiectomy were performed. The CANCRS scale was used to assess pain by evaluating the rabbit preoperatively, 6 h postoperatively, and at three time points the following day. Times of return to spontaneous feeding and fecal production were also recorded. No statistically significant difference was found between treatment groups based on CANCRS scores and resumption of food intake and fecal output. No clinically detectable adverse effects were noted. While limitations include the use of a single pain assessment scale and the absence of a placebo control group, the results suggest that both carprofen and meloxicam can be viable options in clinical practice. Further research utilizing diverse pain assessment methods is warranted to enhance understanding and optimize pain management strategies for rabbits undergoing surgical procedures.

Conservative treatment of a synovial cyst in a golden eagle (Aquila chrysaetos) with triamcinolone acetonide.

In human and veterinary medicine, the treatment of synovial cysts involves medical or surgical approach. When medical treatment is chosen, triamcinolone acetonide is one of the most used drugs. In this case, intracystic triamcinolone was administered for the treatment of a non-infectious elbow synovial cyst in a subadult female Golden eagle (Aquila chrysaetos), unable to fly. The bird was brought to a wildlife rescue center after an aerial fight with a conspecific. After the treatment, no clinically detectable adverse effects were noted and there was no recurrence within two weeks. Given the improvement of the clinical conditions and the recovery of flight ability, the animal was released back into the wild 17 days after administration of the drug.

Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy.

The use of local anesthetics for castration is both simple and cost-effective, and it may contribute to reducing the anesthetic requirements. Despite its common use in clinical practice, the literature regarding the effects of intratesticular lidocaine in rabbits is limited. In this study, nine rabbits per group were assigned to intratesticularly receive either 2% lidocaine (0.05 mL/kg into each testicle) or an equivalent volume of saline prior to elective orchiectomy. Anesthesia was induced by intranasal administration of ketamine, medetomidine, and butorphanol. During intraoperative assessment, no significant differences in vital parameters (heart rate, respiratory rate, and peripheral saturation of oxygen) were observed between the groups. However, rabbits receiving intratesticular saline displayed a higher incidence of responses to surgical stimuli. Postoperative pain was evaluated using the composite Centro Animali Non Convenzionali Rabbit Scale (CANCRS), revealing a significantly lower score at the initial post-surgery assessment in rabbits treated with intratesticular lidocaine. All subjects exhibited rapid resumption of food intake and fecal output. While all rabbits demonstrated satisfactory perioperative performances, the use of intratesticular lidocaine was associated with a diminished response to surgical stimuli. Consequently, this practice has the potential to reduce the requirement for additional anesthetics or analgesics, promoting faster recovery.

Seismic assessment of bridges through structural health monitoring: a state-of-the-art review.

The present work offers a comprehensive overview of methods related to condition assessment of bridges through Structural Health Monitoring (SHM) procedures, with a particular interest on aspects of seismic assessment. Established techniques pertaining to different levels of the SHM hierarchy, reflecting increasing detail and complexity, are first outlined. A significant portion of this review work is then devoted to the overview of computational intelligence schemes across various aspects of bridge condition assessment, including sensor placement and health tracking. The paper concludes with illustrative examples of two long-span suspension bridges, in which several instrumentation aspects and assessments of seismic response issues are discussed.

Molecular Surveillance for Bocaparvoviruses and Bufaviruses in the European Hedgehog (Erinaceus europaeus).

The presence of bocaparvoviruses (BoVs) and bufaviruses (BuVs) in the European hedgehog (Erinaceus europaeus) was investigated by screening duodenal and liver samples collected from 183 carcasses, delivered to wildlife rescue centers located in northwestern Italy. BoV DNA was detected in 15 animals (8.2%), with prevalences of 7.1% (13/183) and 2.7% (5/183) in intestine and liver samples, respectively. Upon the sequence analyses of the NS1 gene, two highly divergent BoVs (65.5-67.8% nt identities) were identified. Fourteen strains showed the highest identity (98.3-99.4% nt) to the hedgehog BoV strains recently detected in China in Amur hedgehogs (Erinaceus amurensis), whilst four strains were genetically related (98.9-99.4% nt identities) to the porcine BoVs identified in pigs and classified in the species Bocaparvovirus ungulate 4, which included related viruses also found in rats, minks, shrews, and mice. BuV DNA was detected in the duodenal samples of two hedgehogs, with a prevalence rate of 1.1%. The nearly full-length genome of two BuV strains, Hedgehog/331DU-2022/ITA and Hedgehog/1278DU/2019/ITA, was reconstructed. Upon phylogenetic analysis based on the NS and VP aa sequences, the Italian hedgehog BuVs tightly clustered with the BuVs recently identified in the Chinese Amur hedgehogs, within a potential novel candidate species of the genus Protoparvovirus.

Main causes of death of free-ranging bats in Turin province (North-Western Italy): gross and histological findings and emergent virus surveillance.

BACKGROUND: Bats are recognized as reservoir species for multiple viruses. However, little is known on bats' health and mortality. Thus, this study aimed to investigate the main causes of death of bats from Turin province (North-western Italy) and to describe gross and histopathological lesions potentially associated with the presence of selected bat viruses. RESULTS: A total of 71 bats belonging to 9 different species of the families Vespertilionidae and Molossidae were necropsied and samples of the main organs were submitted to histopathological examination. Also, aliquots of the small intestine, liver, spleen, lung, and brain were collected and submitted to biomolecular investigation for the identification of Coronaviridae, Poxviridae, Reoviridae (Mammalian orthoreovirus species), Rhabdoviridae (Vaprio ledantevirus and Lyssavirus species) and Kobuvirus. The majority of bats died from traumatic lesions due to unknown trauma or predation (n = 40/71, 56.3%), followed by emaciation (n = 13/71,18.3%). The main observed gross lesions were patagium and skin lesions (n = 23/71, 32.4%), forelimbs fractures (n = 15/71, 21.1%) and gastric distension (n = 10/71,14.1%). Histologically, the main lesions consisted of lymphoplasmacytic pneumonia (n = 24/71, 33.8%), skin/patagium dermatitis (n = 23/71, 32.4%), liver steatosis and hepatitis (n = 12, 16.9%), and white pulp depletion in the spleen (n = 7/71, 9.8%). Regarding emergent bat viruses, only poxvirus (n = 2, 2.8%) and orthoreovirus (n = 12/71, 16.9%) were detected in a low percentage of bats. CONCLUSIONS: Trauma is the main lesion observed in bats collected in Turin province (North-western Italy) associated with forelimb fractures and the detected viral positivity rate seems to suggest that they did not represent a threat for human health.

Frustrated Total Internal Reflection Measurement System for Pilot Inceptor Grip Pressure.

Sensing the interaction between the pilot and the control inceptors can provide important information about the pilot's activity during flight, potentially enabling the objective measurement of the pilot workload, the application of preventive actions against loss of situational awareness, and the identification of the insurgence of adverse couplings with the vehicle dynamics. This work presents an innovative pressure-sensing device developed to be seamlessly integrated into the grips of conventional aircraft control inceptors. The sensor, based on frustrated total internal reflection of light, is composed of low-cost elements and can be easily manufactured to be applicable to different hand pressure ranges. The characteristics of the sensor are first demonstrated in laboratory calibration tests. Subsequently, applications in flight simulator testing are presented, focusing on the objective representation of the pilot's instantaneous workload.

Intranasal Atomization of Ketamine, Medetomidine and Butorphanol in Pet Rabbits Using a Mucosal Atomization Device.

A non-invasive method of drug delivery, intranasal atomization, has shown positive results in human medicine and in some animal species. The objective of this study was to evaluate the effects of intranasal atomization, compared to intramuscular administration, of a mix of anesthetic drugs in pet rabbits. In total, 104 mixed-breed pet rabbits, undergoing various types of surgery, received a combination of ketamine, medetomidine, and butorphanol (20, 0.4, and 0.2 mg/kg) by intranasal atomization using a Mucosal Atomization Device (Group MAD) or intramuscular administration (Group IM). When required, isoflurane was dispensed through a face mask. At the end of the procedures, atipamezole was administered using the same routes in the respective Groups. There were no differences in time to loss of righting reflex between the groups, while differences were found for the need for isoflurane (higher in Group MAD) and recovery time, occurring earlier in Group MAD. The results suggest that intranasal atomization of a combination of ketamine, medetomidine, and butorphanol produces a lighter depth of anesthesia in pet rabbits, compared to intramuscular administration. Intranasal atomization can be performed to administer sedative and anesthetic drugs, avoiding the algic stimulus related to the intramuscular inoculation of drugs.

Laparoscopic Salpingectomy and Vasectomy to Inhibit Fertility in Free-Ranging Nutrias (Myocastor coypus).

The nutria (Myocastor coypus), an invasive alien species, is widely spread in Europe. Pursuant to regulation (EU) no. 1143/2014, the nutria is subject to management programs to reduce its spread. Surgical fertility control is considered an acceptable method, particularly in urban circumstances, avoiding euthanasia. To maintain the hormonal patterns and the social and behavioral dynamics, surgical infertilization preserving the gonads (i.e., salpingectomy and vasectomy) is recommended. Mini-invasive surgery is an eligible choice when dealing with wildlife, allowing reduced captivation time. For these reasons, 77 free-ranging nutrias, captured in urban nuclei in Italy, underwent infertilization under general anesthesia; laparoscopic salpingectomy and vasectomy were performed on 32 animals and traditional surgery on the remainder, leaving the gonads in place. A three-port technique was used, with two paramedian trocars (5 mm) for the instruments and a median one for the telescope. Ablation was obtained through Onemytis® plasma device, allowing a rapid surgical time with no need to place visceral sutures; the skin was surgically closed. After recovery, the animals were released, and no overt complications were noted. No modification of the behavioral patterns was noted, and the population decreased during the following months.

Antibiotic resistant Escherichia coli in wild birds hospitalised in a wildlife rescue centre.

The aim of this work was to evaluate the consequence of a hospitalisation period on antimicrobial resistance in Escherichia coli isolated from wild bird species admitted in the wildlife rescue centre of the Department of Veterinary Sciences (Turin University, Italy). Samples were collected from 121 raptors and 51 synanthropic animals, at the time of arrival as well as 5 and 10 days afterwards for a total of 372 faecal samples, and the susceptibility of E. coli strains was tested to a panel of seven antibacterials. Of the total, 109 animals (63.37 %) presented at least one sample positive for E. coli, 36 strains (39.6 %) were multi-drug resistant (MDR) and 12 (13.2 %) were extended spectrum beta-lactamase (ESBL)-producing E. coli. During the first 10 days of hospitalisation E. coli strains increased the number of resistances towards each antimicrobial principle, the number of ESBL E. coli and the therapy with fluoroquinolones developed resistance towards ceftriaxone, marbofloxacin, sulfamethoxazole-trimethoprim and tetracycline. Our results suggest that wild birds act as reservoirs of MDR bacteria, being potential sources for their spreading in the environment and to other species.

A composite scale to recognize abdominal pain and its variation over time in response to analgesia in rabbits.

OBJECTIVE: To refine a composite scale for pain evaluation in rabbits and evaluate it for pain variations over time. To determine the differences between objective-Centro Animali Non Convenzionali Rabbit Scale (CANCRS) and subjective-Visual Analogue Scale (VAS) in assessing abdominal pain. STUDY DESIGN: Observational case-control study. ANIMALS: A total of 86 rabbits, 47 healthy animals and 39 animals with gastrointestinal stasis syndrome (RGIS), participated in the study; of 39 animals with RGIS, 32 animals participated in the second part of the study. METHODS: In part 1, rabbits underwent pain assessments with VAS and CANCRS. In part 2, the animals underwent four pain assessments with three CANCRS. The first assessment was performed prior to pain management, the others after 30, 60 and 90 minutes. Statistics included Mann-Whitney U test for in-between group comparisons and analysis of variance to assess differences over time. Sensitivity and specificity for each variable of CANCRS were calculated to obtain weighting factors. RESULTS: CANCRS showed differences between healthy and diseased rabbits (p = 0.0001), and median scores were 5 [interquartile range (IQR): 4-6) and 9 (IQR: 7-11), respectively. VAS showed differences between healthy and diseased rabbits (p = 0.02), and median scores were 4 (IQR: 2-5.35) and 5.3 (IQR: 2.65-6.45), respectively. The cut-off scores for CANCRS and VAS for differentiation between healthy and diseased rabbits were 7 (specificity 89%, sensitivity 79%) and 4.4 (specificity 59%, sensitivity 69%), respectively. Internal validity testing of CANCRS was significant at each time point. CONCLUSIONS AND CLINICAL RELEVANCE: Some variables should be excluded from CANCRS when assessing abdominal pain. CANCRS performed better than VAS, and it detected variations in pain in response to analgesia.

FIELD ANESTHESIA OF FREE-RANGING NUTRIAS (MYOCASTOR COYPUS) FOR SURGICAL REPRODUCTION CONTROL.

The nutria (Myocastor coypus), a rodent native to South America, has been introduced and has established feral populations at numerous locations in North America, Europe, and Asia. As such, the nutria is subject to research and management programs, including investigation of surgical fertility-control techniques. We evaluated the efficacy of a mixture of ketamine and medetomidine, with additional use of isoflurane and reversal with atipamezole, to provide safe, reliable anesthesia for surgical procedures under field conditions. We anesthetized 40 free-ranging nutrias between December 2018 and March 2019, in Turin, Italy, to perform surgical reproduction control techniques. We administered a ketamine and medetomidine mixture (6 mg/kg and 140 µg/kg, respectively) after trapping the animals and weighing them in the cage traps. After induction, we reweighed the rodents and performed a brief clinical examination. The times of loss of palpebral and pedal reflexes were noted. After induction of anesthesia, heart rate, respiratory rate, and percentage of oxygen saturation were monitored and recorded. Isoflurane was delivered through a face mask to 27 nutrias (70%) to maintain an adequate depth of anesthesia. Upon completion of surgery and other procedures, atipamezole was administered to the animals at doses 2.5 higher than those of medetomidine (actual dose: 366±31 µg/kg). Induction times were short (3±2 min), with the animals completely immobilized. The heart rate and respiratory rate both decreased. After administration of atipamezole, recoveries were smooth and complete. There were two deaths after higher doses of atipamezole and longer surgeries. Carprofen (4 mg/kg) was administered subcutaneously for its analgesic effects. The animals were released at the end of all the procedures. Overall, the medetomidine and ketamine mixture, with supplemental isoflurane in most instances, provided a reliable anesthesia in free-ranging nutrias, adequate for performing surgical procedures under field conditions.

Successful Treatment of Pyometra Caused by Pseudomonas aeruginosa Infection in a Rabbit.

This article reports an unusual presentation of pyometra in a pet rabbit. A 2-year-old mixed-breed female rabbit with pelvic limb paralysis was referred for abdominal distension associated with prolonged depression and decreased appetite. Clinical examination and diagnostic imaging (radiographs and ultrasound) led to the provisional diagnosis of pyometra that was caused by the presence of an enlarged organ containing fluid material and occupying most of the caudal abdomen. Exploratory laparotomy was performed under general anesthesia. After abdominal wall incision along the linea alba, the uterus was immediately evident and the uterine wall was over-distended and damaged, with purulent material free in the abdominal cavity. Ovariohysterectomy was performed and uterine wall samples were sent for microbiological examination and antimicrobial susceptibility testing. The agent causing the pyometra was found to be Pseudomonas aeruginosa, which was resistant to enrofloxacin and ceftazidime. This is the first report of pyometra caused by P. aeruginosa in a pet rabbit, based on a literature search. Furthermore, a peculiarity of the present case is the occurrence of pyometra in a rabbit with no history of mating or parturition.

Understanding COVID-19 nonlinear multi-scale dynamic spreading in Italy.

The outbreak of COVID-19 in Italy took place in Lombardia, a densely populated and highly industrialized northern region, and spread across the northern and central part of Italy according to quite different temporal and spatial patterns. In this work, a multi-scale territorial analysis of the pandemic is carried out using various models and data-driven approaches. Specifically, a logistic regression is employed to capture the evolution of the total positive cases in each region and throughout Italy, and an enhanced version of a SIR-type model is tuned to fit the different territorial epidemic dynamics via a differential evolution algorithm. Hierarchical clustering and multidimensional analysis are further exploited to reveal the similarities/dissimilarities of the remarkably different geographical epidemic developments. The combination of parametric identifications and multi-scale data-driven analyses paves the way toward a closer understanding of the nonlinear, spatially nonuniform epidemic spreading in Italy.

Relationships Among Delayed Sleep Phase Disorder, Emotional Dysregulation, and Affective Temperaments in Adults With Attention Deficit Hyperactivity Disorder and Cyclothymia.

This study aims to explore the relationships between delayed sleep phase disorder (DSPD) and emotional dysregulation in 240 patients (134 with cyclothymia, 81 with attention deficit hyperactivity disorder [ADHD] and 25 with both conditions). DSPD was assessed using the Morningness-Eveningness Questionnaire, followed by a clinical evaluation. Affective temperaments and emotional dysregulation were also investigated through the brief version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego and the Reactivity, Intensity, Polarity, Stability questionnaires, respectively. Clinical variables were compared in patients with and without DSPD, and a logistic regression model was used to identify the predictive value of the clinical characteristics on the presence of DSPD. DSPD patients (19% of the total sample) were significantly younger than patients without DSPD, showed an about 4 times higher lifetime history of comorbid ADHD and cyclothymia, and reported higher scores in the irritable and cyclothymic temperamental subscales and in the affective instability and impulsivity dimensions. In the multiple logistic regression, we found a negative predictive value of increasing age on the presence of DSPD, whereas comorbid cyclothymia and ADHD and cyclothymic temperament seem to represent risk factors for DSPD.

Reliability and construct validity of a composite pain scale for rabbit (CANCRS) in a clinical environment.

A composite pain scale for assessing and quantifying pain in rabbits (CANCRS) has been designed merging the Rabbit Grimace Scale (RbtGS) and a scale including clinical parameters (CPS). Construct validity and inter-rater reliability were assessed for CANCRS, for RbtGS and for CPS, in order to test their potential to detect pain in a clinical setting. Rabbits (n = 116) were either hybrids or purebreds and they were independently evaluated by two raters, who could be veterinarians (V) or veterinary medicine students (S). Score intervals determined four pain classes (No pain, Discomfort, Moderate pain and Severe pain) that matched presumptive pain classes associated with some pathological conditions. A chi-square test was used to assess the construct validity of the scales by checking how frequently scale results and presumptive pain classes matched. Sixty-nine patients were evaluated by one V and one S, whereas forty-seven rabbits were assessed by two V, in order to test inter-rater reliability. An intra-class correlation coefficient (ICC) was used to test reliability of the scales, whereas Cohen's kappa tested inter-rater agreement for each parameter of the CANCRS. Construct validity results show that CANCRS and RbtGS efficiently reveal pain (P ≤ 0.05), while CPS does not (p > 0.05). Inter-rater reliability was very good for both CANCRS and CPS (ICC 0.88 V-V, 0.94 between V-S; ICC 0.97 V-V, 0.91 V-S) and good for RbtGS (ICC 0.77 V-V, 0.88 V-S); therefore, CPS reproducibility was better between veterinarians and students than between veterinarians. Inter-rater agreement between veterinarians and veterinary medicine students was moderate to very good for all the parameters included in the CANCRS (Cohen's kappa >0,60). In conclusion, it is possible to state that the CANCRS has construct validity and it is a reliable tool for use in clinical practice, when coping with many rabbits with morphological differences. It is easy and fast to use and enriches the RbtGS with some clinical parameters that should be monitored during any clinical examination, allowing for capture of the multidimensional aspect of pain.

Bilateral Pentadactyly in an Immature Alpine Swift (Tachymarptis melba).

An immature Alpine swift (Tachymarptis melba) that presented to a wildlife rehabilitation center was observed to have bilateral pentadactyly on examination. The supernumerary digits did not appear to cause discomfort for the bird, and no motor deficits were apparent. The skin and nails of the digits appeared normal. Radiographically, the extra digits appeared to be composed of two phalanges. The male swift was housed and fed an insectivore diet until it was fully fledged and demonstrated good flying ability. After 16 days of hospitalization, hand-feeding, and flight training, the bird was released to the wild. To our knowledge, this is the first case described of bilateral pentadactyly in an Alpine swift.

Comparison of different methods of semen cryopreservation in Melopsittacus undulatus.

Melopsittacus undulatus is largely used as a potential model for assisted reproduction in other endangered parrot species. Semen was collected from nineteen healthy adult males, by massage technique, during the breeding season. After preliminary evaluations through CASA analysis, eight birds were selected as semen donors and five ejaculates of each bird were utilized to evaluate the effect of 10% ethylene glycol (EG) addition, in two times, during 40min of equilibration time at 4°C, and to compare two programmable freezing curves (a rapid and a slow temperature descent rate) and freezing on nitrogen vapors. Diluted semen (modified TALP, pH 8.4) was divided into two aliquots, the first for freezing individual samples, the second to be mixed in a semen pool from the eight birds. Potential inseminating doses of 10µl, containing 1×106 spermatozoa, were frozen. The effect of EG addition on semen motility and kinetic parameters was analyzed and the three freezing methods were compared. EG addition caused a significant decline of semen motility in individual samples, not in semen pools. The three freezing curves resulted in significant differences in thawed-semen parameters, with nitrogen vapors showing the worst results, while the higher total and progressive motility values were obtained with the 'fast' protocol. Thawed-semen pools motility and kinetic parameters appeared lower than those of the individual ejaculates. The differences found between single ejaculates and semen pools emphasize the importance of performing artificial insemination tests in order to assess the in vivo performance of single ejaculates in the parrot species.

Comparison of celioscopy and histological examinations to assess male gonadal health and functionality in adults and immature wild raptors.

Celioscopy is routinely used in birds for sex determination and diagnostic purposes. Aim of this work was to validate celioscopy for the assessment of male gonads functionality in wild raptors, comparing the results of direct observation with morphometrical and histological characteristics. The work was done at the 'Centro Animali Non Convenzionali' of the University of Turin, Italy, on 31 endoscopically evaluated raptors that died or were euthanized. Through celioscopic observation, the birds were classified in adults or immatures and maturity categories were defined according to the adrenal-gonad size ratio and to the degree of blood filling of testicular vessels. The gonads were removed immediately after death/euthanasia and measured. Albuginea tunic thickness, diameter of seminiferous tubules, number of meiosis figures, tubular development degree, tubular degeneration degree and germinal cells production degree were evaluated. Testicular size tended to increase from immature to adult birds and from 'out of' to 'in' breeding season; albuginea tunic thickness tended to be higher out of the reproductive season while diameter of the seminiferous tubules, germinative epithelium thickness and number of meiosis figures were higher in the breeding season. In season adults generally showed higher values in tubular development and germinal cells production, and lower degrees of tubular cells degeneration and fibrosis. From the interpretation of all the morphometrical and histological aspects, a general reproductive degree of activity was given to the birds and compared with celioscopic results. A perfect concordance was found in 23 out of 31 cases and a good concordance in six ones; histology could describe obviously better sub-clinical conditions undetectable at direct observation. These preliminary results suggest that celioscopy could be a useful tool to assess male gonads functionality in wild raptors, with the future goal to select the better potential semen donors.

Long-term lithium treatment in bipolar disorder: effects on glomerular filtration rate and other metabolic parameters.

BACKGROUND: Concerns about potential adverse effects of long-term exposure to lithium as a mood-stabilizing treatment notably include altered renal function. However, the incidence of severe renal dysfunction; rate of decline over time; effects of lithium dose, serum concentration, and duration of treatment; relative effects of lithium exposure vs. aging; and contributions of sex and other factors all remain unclear. METHODS: Accordingly, we acquired data from 12 collaborating international sites and 312 bipolar disorder patients (6142 person-years, 2669 assays) treated with lithium carbonate for 8-48 (mean 18) years and aged 20-89 (mean 56) years. We evaluated changes of estimated glomerular filtration rate (eGFR) as well as serum creatinine, urea-nitrogen, and glucose concentrations, white blood cell count, and body-mass index, and tested associations of eGFR with selected factors, using standard bivariate contrasts and regression modeling. RESULTS: Overall, 29.5% of subjects experienced at least one low value of eGFR (<60 mL/min/1.73 m2), most after ≥15 years of treatment and age > 55; risk of ≥2 low values was 18.1%; none experienced end-stage renal failure. eGFR declined by 0.71%/year of age and 0.92%/year of treatment, both by 19% more among women than men. Mean serum creatinine increased from 0.87 to 1.17 mg/dL, BUN from 23.7 to 33.1 mg/dL, glucose from 88 to 122 mg/dL, and BMI from 25.9 to 26.6 kg/m2. By multivariate regression, risk factors for declining eGFR ranked: longer lithium treatment, lower lithium dose, higher serum lithium concentration, older age, and medical comorbidity. Later low eGFR was also predicted by lower initial eGFR, and starting lithium at age ≥ 40 years. LIMITATIONS: Control data for age-matched subjects not exposed to lithium were lacking. CONCLUSIONS: Long-term lithium treatment was associated with gradual decline of renal functioning (eGFR) by about 30% more than that was associated with aging alone. Risk of subnormal eGFR was from 18.1% (≥2 low values) to 29.5% (≥1 low value), requiring about 30 years of exposure. Additional risk factors for low eGFR were higher serum lithium level, longer lithium treatment, lower initial eGFR, and medical comorbidity, as well as older age.