Successful treatment with tolvaptan to control blood volume and hyponatremia in a
chronic kidney disease patient
#MMPMID28509063
Yamazaki T
; Morishita Y
; Yoshida N
; Saito O
; Takemoto F
; Ando Y
; Muto S
; Yumura W
; Kusano E
CEN Case Rep
2012[Nov]; 1
(2
): 82-85
PMID28509063
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We report a case of successful treatment with tolvaptan (15 mg/day) in a
73-year-old female patient with chronic kidney disease (CKD) stage 5 due to
diabetic nephropathy and renal sclerosis for volume control and loop
diuretic-induced hyponatremia. Her creatinine clearance has remained at
7-10 ml/min for the last 6 months. She was treated by dietary and drug therapy,
namely, antihypertensives (nifedipine: 40 mg/day, olmesartan: 20 mg/day) and loop
diuretics (azosemide: 40-120 mg/day), for CKD and concomitant diseases of
hypertension and diabetic mellitus. She developed loop diuretic-induced
hyponatremia (120 mmol/l) by increased sodium excretion, but the diuretic was
required for the control of volume overload. Hence, azosemide was suspended and
tolvaptan (15 mg/day) was administered. After tolvaptan treatment, the plasma
sodium level gradually increased to a normal level (135-140 mmol/l) and volume
overload was improved. Urine volume was maintained at about 1000 ml/day with low
sodium excretion (<40 mmol/day) and increased free water clearance. These results
suggest that tolvaptan may be effective for volume control and diuretic-induced
hyponatremia in CKD patients.
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