Tolvaptan therapy to treat severe hyponatremia in pediatric nephrotic syndrome

Delbet, Jean-Daniel; Parmentier, Cyrielle; Ulinski, Tim

doi:10.1007/s00467-020-04530-6

Cited by 7 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The correlation between basal sodium and increase induced by vaptans was studied in 22 hyponatraemic cases 11–14,16,18–24,28,29,32–34 . In these patients, the increase in sodium level after 48 hours significantly ( P < .01) correlated with its basal value (Figure 3).…”

Section: Resultsmentioning

confidence: 95%

“…The literature search process is summarized in Figure 1. For the final analysis, we retained 26 reports published since 2008 9,11–35 : ten from Asia (Japan, n = 7; Turkey, n = 3), eight from Europe (United Kingdom, n = 3; Germany, n = 2; France, n = 1; Italy, n = 1; Spain, n = 1) and eight from the United States. The included articles described 226 patients.…”

Section: Resultsmentioning

confidence: 99%

“…An initial oral tolvaptan dose of 0.38 ± 0.27 mg/kg body weight was given in 106 cases 11–25,27–34,36 . An identical tolvaptan dose was administered 24 hours later in 92 cases 11–14,16,18–25,27–29,32–34 .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Piffer

Bianchetti

Leoni-Foglia

et al. 2022

Brit J Clinical Pharma

View full text Add to dashboard Cite

Aims The aim of this study was to systematically review the use of vaptans (nonpeptide vasopressin receptor antagonists) in children. Methods Through a database search (Web of Science, the National Library of Medicine, Excerpta Medica), we identified case series and case reports and extracted clinical and laboratory data. Results Twenty‐six articles, published since 2008, reported on 226 patients. Among 115 children with hyponatraemic (n = 63) and oedematous disorders (n = 52), a 48 hour course of tolvaptan with an initial dose of 0.38 ± 0.27 mg/kg was administered in 106 cases, while intravenous conivaptan was reported in nine cases. An increase (P < .02) in urine output was shown in both oedematous (from 3.2 ± 2.0 to 5.3 ± 6.7 mL/kg/day) and hyponatraemic (from 3.0 ± 1.5 to 4.4 ± 2.3 mL/kg/day) patients. In these latter, sodium increased from 125 ± 6 to 133 ± 6 mmol/L (P < .0001). The increase in sodium level correlated with its basal value, but not with the administered vaptan dose. Among 111 children undergoing cardiac surgery, after tolvaptan 0.21 ± 0.01 mg/kg/day, mostly combined with conventional diuretics, an increase in diuresis by 41 ± 4% was seen within 24 hours (P < .0001). Similarly, a single add‐on dose of tolvaptan 0.45 mg/kg allowed a reduced additional intravenous furosemide administration (0.26 ± 0.23 vs 0.62 ± 0.48 mg/kg, P < .005). Side effects were rarely reported, and included excessive thirst and xerostomia in seven, skin rash in one and elevated aminotransferases in one patient(s). Conclusion Vaptans appear to be safe for oedematous and hyponatraemic disorders also in children. Although they increase diuresis and natraemia, no superiority to traditional diuretics and sodium supplements has been demonstrated. Reported side effects are rare and non‐serious.

show abstract

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Piffer

Bianchetti

Leoni-Foglia

et al. 2022

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Increased urinary sodium excretion from the use of furosemide also exacerbates hyponatremia. Delbet et al [9] reported the efficacy of TLV in a pediatric NS patient with severe hyponatremia. In the present case, TLV treatment decreased the concentration of U-Na + K and increased free water excretion.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of oral tolvaptan for severe edema and hyponatremia in a patient with refractory nephrotic syndrome

2021

View full text Add to dashboard Cite

Tolvaptan (TLV) is a vasopressin V2 receptor antagonist that increases free water excretion. However, there are few reports of the use of TLV in pediatric patients with nephrotic syndrome (NS). The efficacy of TLV for the management of edema and hyponatremia in a 12-year-old boy with refractory NS is demonstrated. In this patient, refractory NS developed at 5 years of age, and remission was maintained with several immunosuppressive agents. He was admitted to hospital due to relapse with oliguria, edema, hypoalbuminemia, and hyponatremia. Infusion of human albumin and furosemide did not increase his urine volume, and hyponatremia worsened. Administration of TLV increased urine volume and improved his edema and hyponatremia. There were no adverse effects except for slow elevation of the serum sodium level. Serum osmolality increased gradually, and urine osmolality remained at low levels during TLV treatment. Additionally, a decrease in the sum of the urinary sodium and potassium concentrations was useful to predict the response to TLV and to assess the therapeutic effect of TLV as a biomarker for monitoring. TLV is effective for the management of fluid and electrolyte balance in pediatric NS patients. Early administration of TLV is considered a useful therapy for hyponatremia and refractory edema resistant to other diuretics.

show abstract

“…The second case of tolvaptan use is in a neonate with severe ADPKD in the UK; tolvaptan administration relieved edema, but the kidneys remained enlarged [31]. Tolvaptan has also been used to successfully treat pediatric syndrome of inappropriate antidiuretic hormone as well as severe hyponatremia in pediatric nephrotic syndrome [32][33][34].…”

Section: Trials and Case Studies On Pediatric Adpkdmentioning

confidence: 99%

Tolvaptan in Pediatric Autosomal Dominant Polycystic Kidney Disease: From Here to Where?

et al. 2021

View full text Add to dashboard Cite

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder, accounting for approximately 5% of all ESRD cases worldwide. As a vasopressin receptor 2 antagonist, tolvaptan is the FDA-approved therapeutic agent for ADPKD, which is only made available to a limited number of adult patients; however, its efficacy in pediatric patients has not been reported widely. Summary: Tolvaptan was shown to delay ADPKD progression in the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4 study, Replicating Evidence of Preserved Renal Function: an Investigation of Tolvaptan Safety and Efficacy in ADPKD (REPRISE) trial, and other clinical studies. In addition to its effects on aquaretic adverse events and alanine aminotransferase elevation, the effect of tolvaptan on ADPKD is clear, sustained, and cumulative. While ADPKD is a progressive disease, the early intervention has been shown to be important and beneficial in hypotheses as well as in trials. The use of tolvaptan in pediatric ADPKD involves the following challenges: patient assessment, quality of life assessment, cost-effectiveness, safety, and tolerability. The ongoing, phase 3b, 2-part study (ClinicalTrials.gov identifier: NCT02964273) on the evaluation of tolvaptan in pediatric ADPKD (patients aged 12–17 years) may help obtain some insights. Key Messages: This review focuses on the rationality of tolvaptan use in pediatric patients with ADPKD, the associated challenges, and the suggested therapeutic approaches.

show abstract

Tolvaptan therapy to treat severe hyponatremia in pediatric nephrotic syndrome

Cited by 7 publications

References 15 publications

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Efficacy of oral tolvaptan for severe edema and hyponatremia in a patient with refractory nephrotic syndrome

Tolvaptan in Pediatric Autosomal Dominant Polycystic Kidney Disease: From Here to Where?

Contact Info

Product

Resources

About