Different Effects of Tolvaptan in Patients with Idiopathic Membranous Nephropathy with Nephrotic Syndrome

Tanaka, Atsushi; Nakamura, Tsukasa; Satô, Eiichi; Ueda, Yoshihiko; Node, Koichi

doi:10.2169/internalmedicine.56.7539

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…Tolvaptan is effective for correcting hyponatremia in patients with SIADH. On the other hand, tolvaptan has inconsistent effects in patients with edema due to causes other than congestive heart failure and liver cirrhosis 10) . Generalized edema in patients with ALS has yet to be characterized, and there is no consensus on effective treatments.…”

Section: Discussionmentioning

confidence: 99%

Edematous Hyponatremia Treated with Tolvaptan in a Patient with Amyotrophic Lateral Sclerosis

Kim

2017

Electrolyte Blood Press

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Amyotrophic lateral sclerosis (ALS) patients rarely present with either syndrome of inappropriate antidiuretic hormone secretion or generalized edema. Tolvaptan is a selective vasopressin V2 receptor antagonist that produces effective aquaresis, and its use in ALS patients has not been previously reported. A 50-year-old male ALS patient was admitted because of both generalized edema and dilutional hyponatremia. These manifestations were refractory to conventional diuretics and fluid therapy, but a very brisk diuresis was induced by tolvaptan administration. Edema and hyponatremia were also improved, and the patient was able to be discharged without tolvaptan. In this case report, we postulate how edema and dilutional hyponatremia developed in the patient, and discuss the mechanism of tolvaptan in treating hypervolemic hyponatremia. Further experience is necessary to evaluate the usefulness of tolvaptan in patients with neurological disorders.

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Section: Discussionmentioning

confidence: 99%

Edematous Hyponatremia Treated with Tolvaptan in a Patient with Amyotrophic Lateral Sclerosis

Kim

2017

Electrolyte Blood Press

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“…There are case reports that describe the successful reduction of refractory edema in nephrotic syndrome with the use of Tolvaptan, without being associated with significant adverse effects. However, randomized controlled trials are required to standardize its dosage, duration of treatment and evaluate its safety profile in nephrotic syndrome [67,68].…”

Section: Vasopressin Receptor Antagonists (Avpr)mentioning

confidence: 99%

Proteasuria: The Link between Physiopathogenesis and Edema Management in Nephrotic Syndrome?

Alamilla-Sanchez¹,

Salgado²,

González³

et al. 2024

Novel Topics in the Diagnosis, Treatment, and Follow-Up of Nephritis, Nephrotic Syndrome, and Nephrosis

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Nephrotic syndrome is a pathology characterized by severe proteinuria, hypoalbuminemia, dyslipidemia, and edema. Edema has classically been associated with an alteration of the forces that govern Starling’s principle. However, some proteins eliminated in excess in the urine (proteasuria) can activate the epithelial sodium channel (ENaC), favoring sodium retention and edema. The α- and γ-ENaC subunits are activated by releasing inhibitory segments that favor the probability of channel opening. Some proteases that have been investigated include plasmin, prostasin, transmembrane protease serine 4, cathepsin, and neutrophil elastases. Therapeutic strategies include water and sodium restriction in the diet, appropriate dosing of diuretics (loop, thiazides, or acetazolamide), and in severe cases, mechanical ultrafiltration. Due to the continuous activation of ENaC in nephrotic syndrome, amiloride is an attractive diuretic strategy that has been shown to be effective in some patients with an acceptable safety profile.

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“…These drugs reduce the density of luminal aquaporins to increase urinary water excretion without natriuresis (The National Institute for Health and Care [NICE], 2018). To date there are three case reports on four individuals describing the use of tolvaptan in massive oedema in nephrotic individuals, with treatment described as successful in three out of four cases (Shimizu et al, 2014; Park et al, 2015; Tanaka et al, 2017).…”

Section: Treatment Of Oedemamentioning

confidence: 99%

Nephrotic Syndrome: Oedema Formation and Its Treatment With Diuretics

et al. 2019

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Oedema is a defining element of the nephrotic syndrome. Its’ management varies considerably between clinicians, with no national or international clinical guidelines, and hence variable outcomes. Oedema may have serious sequelae such as immobility, skin breakdown and local or systemic infection. Treatment of nephrotic oedema is often of limited efficacy, with frequent side-effects and interactions with other pharmacotherapy. Here, we describe the current paradigms of oedema in nephrosis, including insights into emerging mechanisms such as the role of the abnormal activation of the epithelial sodium channel in the collecting duct. We then discuss the physiological basis for traditional and novel therapies for the treatment of nephrotic oedema. Despite being the cardinal symptom of nephrosis, few clinical studies guide clinicians to the rational use of therapy. This is reflected in the scarcity of publications in this field; it is time to undertake new clinical trials to direct clinical practice.

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Different Effects of Tolvaptan in Patients with Idiopathic Membranous Nephropathy with Nephrotic Syndrome

Cited by 9 publications

References 15 publications

Edematous Hyponatremia Treated with Tolvaptan in a Patient with Amyotrophic Lateral Sclerosis

Edematous Hyponatremia Treated with Tolvaptan in a Patient with Amyotrophic Lateral Sclerosis

Proteasuria: The Link between Physiopathogenesis and Edema Management in Nephrotic Syndrome?

Nephrotic Syndrome: Oedema Formation and Its Treatment With Diuretics

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