Published in:
Open Access
01-12-2018 | Case report
Case report: a thiazide diuretic to treat polyuria induced by tolvaptan
Authors:
Bart J. Kramers, Maatje D. A. van Gastel, Esther Meijer, Ron T. Gansevoort
Published in:
BMC Nephrology
|
Issue 1/2018
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Abstract
Background
Currently, the vasopressin V2 receptor antagonist tolvaptan is the only available treatment for autosomal dominant polycystic kidney disease (ADPKD), but there are tolerability issues due to aquaretic side-effects such as polyuria. A possible strategy to ameliorate these side-effects may be addition of a thiazide diuretic, this is an established treatment in nephrogenic diabetes insipidus, a condition where vasopressin V2 receptor function is absent.
Case presentation
We describe a 46-year-old male ADPKD-patient, who was prescribed tolvaptan, which caused polyuria of around 5 l per day. Hydrochlorothiazide was added to treat hypertension, which resulted in a marked decrease in urine production. While using tolvaptan, rate of eGFR decline was − 1.35 mL/min/1.73m2 per year, whereas after hydrochlorothiazide was initiated this was − 3.97 mL/minute/1.73m2 per year.
Conclusions
This case report indicates that while addition of hydrochlorothiazide may improve tolerability of vasopressin V2 receptor antagonists, co-prescription should only be used with great scrutiny as it may decrease tolvaptan effect on rate of ADPKD disease progression.