Is tolvaptan indicated for refractory oedema in nephrotic syndrome?

Title
Is tolvaptan indicated for refractory oedema in nephrotic syndrome?
Authors
김근호
Keywords
collecting duct; oedema; nephrotic syndrome; sodium; tolvaptan
Issue Date
2015-02
Publisher
WILEY-BLACKWELL
Citation
NEPHROLOGY, v. 20, NO 2, Page. 103-106
Abstract
Tolvaptan is useful for correcting dilutional hyponatraemia because of its aquaretic effect. On the other hand, there is a distinct lack of data regarding tolvaptan-induced natriuresis, although previous studies have demonstrated improvement of congestive symptoms and signs in heart failure patients following tolvaptan treatment. Here, we report the case of a 47-year-old man diagnosed with minimal change nephrotic syndrome and whose refractory oedema was immediately controlled by tolvaptan before steroid response was induced. With tolvaptan treatment, patient urine output increased dramatically to approximately 5.5L/day and body weight decreased by 9kg over 5 days. Interestingly, urine sodium concentration, fractional excretion of sodium and urine osmolality all increased in response to tolvaptan administration. However, serum sodium concentration was maintained within the normal range, and mild azotaemia was corrected. Tolvaptan was discontinued after 11 days when heavy proteinuria and generalized oedema had been resolved. We discuss the potential mechanisms by which V-2 receptor antagonists may stimulate natriuresis in the kidney. In conclusion, tolvaptan may be useful as an adjunctive treatment for oedematous disorders.
URI
http://onlinelibrary.wiley.com/doi/10.1111/nep.12348/fullhttp://hdl.handle.net/20.500.11754/22269
ISSN
1320-5358; 1440-1797
DOI
http://dx.doi.org/10.1111/nep.12348
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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