title: Effect of tolvaptan in patients with chronic kidney disease due to diabetic nephropathy with heart failure.
abstract: The efficacy of tolvaptan for treating heart failure has already been shown. Adequate data relating to the effect of tolvaptan on the correlation of water balance in renal disease are not available. A retrospective study was conducted on the efficacy and adverse reactions of tolvaptan for treating nephrotic syndrome.The subjects were 26 patients with chronic kidney failure due to diabetic nephropathy with heart failure who were administered tolvaptan and seen between December 2011 and October 2013. The endpoints were urinary output, physical findings, and blood analyses. The expression of aquaporin-2 in the collecting duct, which is related to the action of tolvaptan, was investigated by immunohistochemistry using the kidney tissue obtained for the diagnosis.Responses were seen in 19 of the patients. In the histopathological investigation there was severe glomerulosclerosis in patients with diabetic nephropathy, but the responders were noticeable in that they only had mild tubulointerstitial damage. Non-responders exhibited profound tubulointerstitial damage. The expression of aquaporin-2 was determined in 8 patients, of which 7 were responders who tested positive for aquaporin-2. The remaining case was a non-responder who showed no expression of aquaporin-2.Tolvaptan is considered effective for some cases of nephrotic syndrome. There are no clear parameters for predicting an effect, but the present study showed that aquaporin-2 was expressed in the epithelial cells of the collecting ducts of tolvaptan responders.
authors.affiliation: Department of Pathology, Dokkyo Medical University, Koshigaya Hospital.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Sato
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Mayuko
authors.initials: M
authors.lastname: Amaha
authors.forename: Mayumi
authors.initials: M
authors.lastname: Nomura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumura
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Yamagishi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D051399:Aquaporin 2 / Q000378:metabolism*; D001552:Benzazepines / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D051399:Aquaporin 2; D001552:Benzazepines; D000077602:Tolvaptan