I have been taking lithium carbonate 1350 mg for 12 years. My former psychiatrists would do routine urinalysis with blood draws. My current psychiatrist of 8 years has never tested my kidney function through yearly urinalysis. Has the monitoring of lithium changed? Is it the psychiatrist's job or my General Practitioner's or should I see a urologist for more thorough testing?
As the doctor that prescribes the lithium, your psychiatrist should be regularly checking your kidney, thyroid, and parathyroid function as well as your lithium levels as these organs can be negatively affected by lithium. Failing to do so is irresponsible, and you should find another doctor. However, you can certainly request that your primary care physician check these matters for you when you go in for your regular checkups. The more data about your normal organ function that is collected, the more anomalies will stand out. In long-term treatment with lithium, the treatable and therefore harmless kidney change nephrogenic diabetes insipidus (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001540/) is quite probable, but a very small percentage of people also develop irreversible kidney damage that requires treatment with hemodialysis (Hence the need for very early warning and close monitoring of kidney function). Thyroid change is also quite common, and, although rare among lithium-treated patients, lithium is a leading cause of hyperparathyroidism.