ABSTRACT
Objective To evaluate the efficacy and safety of tolvaptan therapy for edema in patients with nephrotic syndrome(NS).Methods Twelve patients with NS who had normal serum sodium and blood volume were enrolled.All of them were treated with oral tolvaptan of 15-30 mg per day for 7 days.The diuretic effects were observed and the adverse reactions including electrolyte disorders(especially hypernatremia),low blood volume,thromboembolic complications,and acute kidney injury were closely monitored.Results The average urine volume was significantly increased(F=5.792,P ＜ 0.001)and the body weight was significantly decreased(F=24.086,P ＜ 0.001)from the first day of tolvaptan therapy until the end of the treatment.The average serum sodium levels were significantly increased from the second day of tolvaptan therapy until the end of the treatment(F=2.790,P=0.012),but only 3 case-times(3.6％)among the total 84 case-times of serum sodium tests showed mild hypernatremia(the highest level 146.5 mmol/L)and all the hypernatremia returned back to normal after suspending tolvaptan for one day.There were no significant changes in the serum potassium levels(F=0.477,P=0.849)within the whole treatment course.There was also no significant difference of the blood volume between the level at the end of treatment and the baseline level[(74.3± 3.0)ml/kg vs(74.9±3.0)ml/kg,P=0.855].The thromboembolic complications and acute kidney injury both also did not take place.Conclusions As long as a rational and prudent treatment regimen is applied,tolvaptan has good diuretic effects and safety for treatment of edema in the NS patients with normal serum sodium and blood volume.