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2017 ; 6
(1
): 61-65
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Acute pulmonary thromboembolism occurring during treatment with tolvaptan in a
patient with autosomal-dominant polycystic kidney disease
#MMPMID28509130
Morimoto K
; Akai Y
; Matsui M
; Yano H
; Tagawa M
; Samejima KI
; Saito Y
CEN Case Rep
2017[May]; 6
(1
): 61-65
PMID28509130
show ga
Autosomal-dominant polycystic kidney disease (ADPKD) is the most prevalent cystic
kidney disease, with approximately half of the patients reaching end-stage renal
disease by the age of 60. Tolvaptan prevents renal cyst growth by inhibiting
intracellular cyclic AMP and is recommended for patients with ADPKD. Reports of
thrombotic complications with tolvaptan have been limited. We report a case of a
60-year-old man who developed thromboembolisms during tolvaptan treatment for
ADPKD. The patient started tolvaptan in July 2014. He was brought to our hospital
in February 2015 with a sudden onset of dyspnea and chest pain after 6 days of
persistent watery diarrhea. Blood tests revealed enhanced coagulation and
fibrinolysis, and contrast-enhanced computed tomography confirmed the presence of
multiple thromboembolisms. Venous thromboembolism (VTE) with acute pulmonary and
lower extremity thrombi was diagnosed, and the patient was immediately admitted.
Tolvaptan was discontinued on admission, and intravenous fluid loading and
monteplase were started. Subsequently, chest pain and dyspnea resolved, with
thrombi resolution occurring by day 14; the patient was discharged on day 18 in
stable condition. VTE was attributed to continued tolvaptan during diarrhea and
dehydration; tolvaptan itself was not associated with enhanced coagulability.
Dehydrated patients with ADPKD, such as the patient in this case, are at an
increased risk for thrombus formation. Proper education should be provided to
maintain appropriate fluid status and discontinue tolvaptan upon volume
depletion.