Child Kidney Dis.  2023 Dec;27(2):76-81. 10.3339/ckd.23.021.

Tolvaptan: a possible preemptive treatment option in children with autosomal dominant polycystic kidney disease?

• Beak HS
• Cho MH

• KMID: 2549737
• DOI: http://doi.org/10.3339/ckd.23.021

Abstract

Tolvaptan is a highly selective vasopressin receptor 2 antagonist that regulates cyclic adenosine monophosphate levels to inhibit both epithelial cell proliferation and chloride ion excretion, two mechanisms known to induce cyst expansion in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan is currently the preferred treatment of rapidly progressive disease ADPKD in adult patients; however, since cyst formation in ADPKD begins early in life, (frequently in utero), and significant disease progression with cyst expansion occurs in the first decade, tolvaptan may be advantageous as a preemptive treatment in children with ADPKD. Tolvaptan has already been used to successfully treat refractory edema or hyponatremia in children; this literature review provides insight into the biochemical basis of its action to contextualize its use in the pediatric population.

Keyword

Autosomal dominant polycystic kidney; Child; Tolvaptan

Figure

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  Fig. 1. Schematic pathway of chloride-driven fluid excretion in polycystic kidney disease. ADPKD, autosomal dominant polycystic kidney disease; FC, fibrocystin; PC1, polycystin-1; PC2, polycystin-2; ER, endoplasmic reticulum; CFTR, cystic fibrosis transmembrane conductance regulator; PKA, protein kinase A; PDE, phosphodiesterase; AMP, adenosine monophosphate; cAMP, cyclic AMP; ATP, adenosine triphosphate; AC6, adenylyl cyclase type 6; V2R, vasopressin receptor 2; AVP, arginine vasopressin.

Reference

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