Journal
BMC NEPHROLOGY
Volume 19, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12882-018-0957-7
Keywords
ADPKD; Tolvaptan; Hydrochlorothiazide; Polyuria; Polycystic kidney disease
Categories
Funding
- IPSEN Farmaceutica
- Sanofi-Genzyme
- Otsuka
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Background: Currently, the vasopressin V2 receptor antagonist tolvaptan is the only available treatment for autosomal dominant polycystic kidney disease ( DPKD), but there are tolerability issues due to aquaretic side-effects such as polyuria. A possible strategy to ameliorate these side-effects may be addition of a thiazide diuretic, this is an established treatment in nephrogenic diabetes insipidus, a condition where vasopressin V2 receptor function is absent. Case presentation: We describe a 46-year-old male ADPKD-patient, who was prescribed tolvaptan, which caused polyuria of around 5 l per day. Hydrochlorothiazide was added to treat hypertension, which resulted in a marked decrease in urine production. While using tolvaptan, rate of eGFR decline was - 1.35 mL/min/1.73m(2) per year, whereas after hydrochlorothiazide was initiated this was - 3.97 mL/minute/1.73m(2) per year. Conclusions: This case report indicates that while addition of hydrochlorothiazide may improve tolerability of vasopressin V2 receptor antagonists, co-prescription should only be used with great scrutiny as it may decrease tolvaptan effect on rate of ADPKD disease progression.
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