Tolvaptan therapy to treat severe hyponatremia in pediatric nephrotic syndrome.
Pediatr Nephrol
; 35(7): 1347-1350, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-32232633
ABSTRACT
BACKGROUND:
Tolvaptan is a selective oral vasopressin V2-receptor antagonist. Some data have implicated stimulation of arginine vasopressin (AVP) as an important factor in oedema formation in a rodent model of nephrotic syndrome (NS) and adult NS patients. We report case of pediatric NS with severe hyponatremia efficiently treated by tolvaptan. CASE/DIAGNOSIS - TREATMENT A 22-month-old girl presented first with NS. She remained nephrotic after a 30-day course of oral steroids. Tacrolimus was inefficient and there was no response to plasma exchanges (15 sessions on a daily basis). She had severe oedema and ascites. Thus, in addition to immunosuppressive therapy, she received diuretics, furosemide 5 mg/kg/day, and amiloride 1 mg/kg/day, and required water restriction. She was hypertensive and was treated with a full dose of calcium inhibitor (amlodipine 0.5 mg/kg/day). After2 months of treatment, serum sodium reached 116 mmol/L and urinary osmolarity 547 mosmol/L, suggesting an inappropriate AVP secretion. Tolvaptan was introduced at 0.3 mg/kg/day and progressively increased to 3 mg/kg/day on day 4, leading to a partial correction of serum sodium (130 mmol/l) and a urinary osmolarity decrease to 90 mosmol/L. Tolvaptan was then continued at the dose of 3 mg/kg/day with unchanged serum sodium, without hypernatremia or dehydration. Her weight decreased from 14.8 k to 14 k, but oedema still persisted.CONCLUSION:
Tolvaptan was very efficient in this case of hyponatremia associated with steroid-resistant NS. Tolvaptan should be considered in the management of therapy-resistant hyponatremia in patients with NS.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Antagonistas dos Receptores de Hormônios Antidiuréticos
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Tolvaptan
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Hiponatremia
Tipo de estudo:
Etiology_studies
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Prognostic_studies
Limite:
Female
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Humans
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Infant
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article