Management of Liver Function Impairment Due to the Addition of Statin in A Patient Using Tolvaptan for Polycystic Kidney Disease

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, with PKD1 mutations observed in approximately 85% of cases and PKD2 mutations in 10-15%. In ADPKD, renal levels of 3’,5’-cyclic adenosine monophosphate (cAMP) increase, playing a significant role in cyst formation. It has been demonstrated that continuous suppression of vasopressin production, secretion, or its effect prevents cyst formation and preserves kidney function. Tolvaptan acts as a short-acting V2 receptor inhibitor, completely blocking the effects of vasopressin and reducing cyst development. In this case, a patient with ADPKD was undergoing tolvaptan therapy to slow disease progression. Simultaneously, due to the presence of concomitant cardiovascular disease and dyslipidemia, statin therapy was initiated. However, hepatotoxicity was observed during follow-up, necessitating a change from statin to ezetimibe monotherapy to ensure the continuity of tolvaptan treatment.

Keywords

• tolvaptan
• polycystic kidney disease
• hepatotoxicity

Tolvaptan Kullanan Poli̇ki̇sti̇k Böbrek Hastasinda Stati̇n Eklenmesi̇ne Bağlı Karaci̇ğer Fonksi̇yon Bozukluğunun Yönetimi

Abstract

Otozomal dominant polikistik böbrek hastalığı (ODPBH) en sık görülen kalıtsal böbrek hastalığıdır ve olguların %85’inde PKD1, %10-15’inde ise PKD2 gen mutasyonu görülmektedir. ODPBH’de renal 3’,5’-siklik adenozin monofosfat seviyeleri artarak kist oluşumunda önemli rol oynar. Vazopressin üretiminin, salgılanmasının veya etkisinin sürekli baskılanması kist oluşumunu engelleyerek böbrek fonksiyonunun korunmasını sağladığı gösterilmiştir. Tolvaptan kısa etkili V2R inhibitörüdür ve vazopressinin etkisini tamamen bloke ederek kist gelişimini azaltır. Bu vakada ODPBH’de hastalık progresyonunu yavaşlatmak amacıyla tolvaptan tedavisi kullanırken, eşzamanlı Kardiyovasküler hastalık ve dislipidemi nedeniyle statin tedavisi başlanmış ancak takiplerde hepatotoksisite gelişmesine bağlı tolvaptan tedavisinin aksatılmadan devam edilmesi için statin yerine ezetimib monoterapisi tercih edilen hasta sunulmuştur.

Keywords

• tolvaptan
• polikistik böbrek hastalığı
• hepatotoksite

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