Takada Tesshu, Masaki Tsuguto, Hoshiyama Ayako, Toki Takuya, Kamata Yuji, Shichiri Masayoshi
Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Japan.
Nephrology (Carlton). 2018 Sep;23(9):883-886. doi: 10.1111/nep.13390.
Patients with diabetic nephropathy develop nephrotic syndrome and may show limited response to conventional therapy. They often require earlier initiation of renal replacement therapy because they become refractory to diuretics, and experience excessive fluid retention. We aimed to investigate the efficacy of tolvaptan, an oral arginine vasopressin type 2 receptor antagonist, in a case series of 14 severe diabetic renal failure patients who were severely refractory to maximal doses of furosemide and had excessive fluid retention despite preserved cardiac function and residual renal function. All 14 patients experienced immediate and sustained water diuretic effects, resulting in alleviation of congestive heart failure. None required initiation of renal replacement therapy. Tolvaptan promptly increased urine volume and free water clearance, reversed progressive fluid retention, and alleviated congestive heart failure. Thus, tolvaptan could serve as a potential adjunct therapy for severe diabetic renal failure patients with excessive fluid retention and congestive heart failure.
糖尿病肾病患者会出现肾病综合征，且对传统治疗的反应可能有限。他们往往需要更早开始肾脏替代治疗，因为他们对利尿剂产生耐药性，并出现过多的液体潴留。我们旨在研究口服精氨酸加压素2型受体拮抗剂托伐普坦对14例严重糖尿病肾衰竭患者的疗效，这些患者对最大剂量的呋塞米严重耐药，尽管心功能和残余肾功能尚存，但仍有过多的液体潴留。所有14例患者均立即出现并持续产生利水作用，从而缓解了充血性心力衰竭。无人需要开始肾脏替代治疗。托伐普坦迅速增加尿量和自由水清除率，逆转进行性液体潴留，并缓解充血性心力衰竭。因此，托伐普坦可作为有过多液体潴留和充血性心力衰竭的严重糖尿病肾衰竭患者的一种潜在辅助治疗方法。
