title: Tolvaptan in the treatment of acute hyponatremia associated with acute kidney injury.
abstract: Hyponatremia defined as a plasma sodium concentration of less than 135 mmol/L is a very common disorder, occurring in hospitalized patients. Hyponatremia often results from an increase in circulating arginine vasopressin (AVP) levels and/or increased renal sensitivity to AVP, combined with an increased intake of free water. Hyponatremia is subdivided into three groups, depending on clinical history and volume status: hypovolemic, euvolemic, and hypervolemic. Acute symptomatic hyponatremia is usually treated with hypertonic (3%) saline. Syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) and hypervolemic hyponatremia caused by heart failure or cirrhosis are treated with vasopressin antagonists (vaptans) since they increase plasma sodium (Na(2+)) concentration via their aquaretic effects (augmentation of free-water clearance). The role of tolvaptan in the treatment of acute hyponatremia and conversion of oliguric to nonoliguric phase of acute tubular necrosis has not been previously described.
authors.affiliation: Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Gopinath
authors.affiliation: Department of Nephrology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USA.
authors.forename: Kalyana C
authors.initials: KC
authors.lastname: Janga
authors.affiliation: Department of Nephrology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USA.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenberg
authors.affiliation: Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
authors.forename: Shree K
authors.initials: SK
authors.lastname: Sharma