title: A case with recovery of response to tolvaptan associated with remission of acute kidney injury and increased urine osmolality.
abstract: Tolvaptan (TLV), a vasopressin type 2 receptor antagonist, has been demonstrated to be effective in patients with decompensated heart failure (HF) refractory to incremental doses of diuretics, but the responsiveness has not always been predictable. We have recently proposed that urine osmolality (U-OSM) is a valuable parameter for the prediction of responses to TLV, because U-OSM reflects the activity of the collecting ducts, where TLV plays its unique role. Acute kidney injury (AKI) is often associated with severe tubular dysfunction, including the collecting ducts, and in such cases a response to TLV may not be expected. We here experienced a patient with HF and AKI in whom TLV was not effective during AKI. We also observed recovery of responsiveness to TLV along with remission of AKI as well as increased U-OSM later on. We believe that this is the first report on the reversibility of the TLV response in relation to U-OSM.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Shun
authors.initials: S
authors.lastname: Minatsuki
authors.forename: Hironori
authors.initials: H
authors.lastname: Muraoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Taro
authors.initials: T
authors.lastname: Shiga
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Hosoya
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000652:urine; D000293:Adolescent; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D009994:Osmolar Concentration; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan