title: Renal aquaporins and water balance disorders.
abstract: BACKGROUND
  Aquaporins (AQPs) are a family of proteins that can act as water channels. Regulation of AQPs is critical to osmoregulation and the maintenance of body water homeostasis. Eight AQPs are expressed in the kidney of which five have been shown to play a role in body water balance; AQP1, AQP2, AQP3, AQP4 and AQP7. AQP2 in particular is regulated by vasopressin.
  
  
  METHODS
  This review summarizes our current knowledge of the underlying mechanisms of various water balance disorders and their treatment strategies.
  
  
  CONCLUSIONS
  Dysfunctions of AQPs are involved in disorders associated with disturbed water homeostasis. Hyponatremia with increased AQP levels can be caused by diseases with low effective circulating blood volume, such as congestive heart failure, or osmoregulation disorders such as the syndrome of inappropriate secretion of antidiuretic hormone. Treatment consists of fluid restriction, demeclocycline and vasopressin type-2 receptor antagonists. Decreased AQP levels can lead to diabetes insipidus (DI), characterized by polyuria and polydipsia. In central DI, vasopressin production is impaired, while in gestational DI, levels of the vasopressin-degrading enzyme vasopressinase are abnormally increased. Treatment consists of the vasopressin analogue dDAVP. Nephrogenic DI is caused by the inability of the kidney to respond to vasopressin and can be congenital, but is most commonly acquired, usually due to lithium therapy. Treatment consists of sufficient fluid supply, low-solute diet and diuretics.
  
  
  CONCLUSIONS
  In recent years, our understanding of the underlying mechanisms of water balance disorders has increased enormously, which has opened up several possible new treatment strategies. This article is part of a Special Issue entitled Aquaporins.
authors.affiliation: Department of Biomedicine, Aarhus University, Aarhus, Denmark; Center for Interactions of Proteins in Epithelial Transport (InterPrET), Aarhus University, Aarhus, Denmark. Electronic address: mkor@ana.au.dk.
authors.forename: Marleen L A
authors.initials: ML
authors.lastname: Kortenoeven
authors.affiliation: Department of Biomedicine, Aarhus University, Aarhus, Denmark; Center for Interactions of Proteins in Epithelial Transport (InterPrET), Aarhus University, Aarhus, Denmark. Electronic address: rofe@ana.au.dk.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fenton
mesh_terms: D000595:Amino Acid Sequence; D020346:Aquaporins / Q000737:chemistry / Q000235:genetics / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D008969:Molecular Sequence Data; D009154:Mutation; D014882:Water-Electrolyte Balance
chemical_list: D020346:Aquaporins
keywords: Aquaporin; Diabetes insipidus; Heart failure; Kidney; SIADH; Water transport