Clinical Implication of Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease characterized by the growth of numerous fluid-filled cysts in the kidneys. It leads to progressive kidney enlargement and end-stage kidney disease (ESKD) [1,2]. ADPKD is a ciliopathy that involves abnormal cilia structure and function [3]. There are polycystin-1 and polycystin-2 in the kidney tubular cell protruding primary cilium. It has a role in detecting fluid flow and regulating calcium influx that activates an intracellular calcium signaling pathway [4]. In addition, increased levels of arginine vasopressin levels induced increased intracellular adenosine cyclic monophosphate (cAMP) levels in the distal tubule and collecting duct. Tolvaptan is a vasopressin receptor antagonist; it selectively blocks the binding of V2 receptors in tubular cells and reduces fluid secretion, cell proliferation, and cyst development by reducing cAMP [5]. Tolvaptan in ADPKD papISSN 2092-8335 · eISSN 2733-5380 Keimyung Med J [Epub ahead of print] https://doi.org/10.46308/kmj.2022.00059 Original Article