The early effects of lithium on the kidney were studied in rats receiving a moderate daily dose (serum-Li: 0.5 to 0.8 mM per liter) for 3, 7, and 21 days. Enzyme histochemical reactions for acid and alkaline phosphatase, glucose 6-phosphatase, succinate and alpha-glycerophosphate dehydrogenase, and NADH tetrazolium reductase revealed changes confined to distal convoluted tubules and collecting ducts. The distal convoluted were unchanged at 3 days of treatment. At 7 days, a decrease in succinate dehydrogenase and NADH tetrazolium reductase and an increase in alpha-glycerophosphate dehydrogenase were noted. These changes were more conspicuous at 21 days and accompanied by tubular dilation and changes in light microscopic cellular morphology. In the collecting ducts, a cell enlargement and an increase in mitochondrial oxidative enzyme activities began to appear at 3 days, becoming more pronounced at 7 and particularly at 21 days. At 7 and even more at 21 days, a cellular hyperplasia was evident in the collecting ducts, and autoradiography after 3H-thymidine incorporation showed a marked increase in DNA synthesis in the collecting duct cells. The changes observed in the collecting ducts were most pronounced near the limit between the outer and the inner zone of the medulla. In conclusion, the rats developed morphologic changes at 3 to 7 days of treatment. The changes include (1) signs of cellular damage in the distal convoluted tubules and (2) hyperplasia and signs of increased functional activity in the collecting ducts.