Vasopressin beyond water: implications for renal diseases

Purpose of review This review aims to analyze the relationships between arginine vasopressin (AVP) and chronic kidney disease (CKD) and to define the potential of vasopressin receptor antagonists beyond the treatment of water metabolism disorders. Recent findings Experimental studies in rat and observational studies in humans suggest that AVP may play a role in the genesis and exacerbation of renal damage and chronic renal insufficiency. Summary A sustained stimulation of vasopressin receptors induces intrarenal renin-angiotensin system activation, podocyte alterations, glomerular hyperfiltration and hypertrophy eventuating in proteinuria and kidney damage. Furthermore, AVP directly stimulates contraction and proliferation of mesangial cells and accumulation of extracellular matrix and glomerulosclerosis. Whether a chronic increase in water intake (determining a reduction in endogenous AVP levels) and/or the administration of vasopressin receptor antagonists are useful for the prevention and treatment of CKD remains to be tested in clinical trials.