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.
References
- 1. Cornec-Le Gall E, Alam A, Perrone RD. Autosomal dominant polycystic kidney disease. Lancet. 2019;393(10174):919-35. doi: 10.1016/S0140-6736(18)32782-X.
- 2. Pei Y, Obaji J, Dupuis A, Paterson AD, Magistroni R, Dicks E, et al. Unified criteria for ultrasonographic diagnosis of ADPKD. J Am Soc Nephrol. 2009 Jan;20(1):205-12. doi: 10.1681/ASN.2008050507.
- 3. Kim DY, Park JH. Genetic mechanisms of ADPKD. Adv Exp Med Biol. 2016;933:13-22. doi: 10.1007/978-981-10-2041-4_2.
- 4. Belibi FA, Edelstein CL. Unified ultrasonographic diagnostic criteria for polycystic kidney disease. J Am Soc Nephrol. 2009;20(1):6-8. doi: 10.1681/ASN.2008111164.
- 5. Chebib FT, Perrone RD, Chapman AB, Dahl NK, Harris PC, Mrug M, et al. Practical guide for treatment of rapidly progressive ADPKD with Tolvaptan. J Am Soc Nephrol. 2018 Oct;29(10):2458-70. doi: 10.1681/ASN.2018060590.
- 6. Zhan S, Tang M, Liu F, Xia P, Shu M, Wu X. Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events. Cochrane Database Syst Rev. 2018;11(11):CD012502. doi: 10.1002/14651858.CD012502.pub2.
- 7. Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL 2nd, Goldstein LB, et al. American Heart Association Clinical Lipidology, Lipoprotein, Metabolism and Thrombosis Committee, a Joint Committee of the Council on Atherosclerosis, Thrombosis and Vascular Biology and Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019 Feb;39(2):e38-e81. doi: 10.1161/ATV.0000000000000073.
- 8. Watkins PB, Lewis JH, Kaplowitz N, Alpers DH, Blais JD, Smotzer DM, et al. Clinical pattern of Tolvaptan-Associated liver Injury in subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database. Drug Saf. 2015;38(11):1103-13. doi: 10.1007/s40264-015-0327-3.
- 9. Khan SU, Yedlapati SH, Lone AN, Hao Q, Guyatt G, Delvaux N, Bekkering GET, et al. PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: a systematic review and network meta-analysis. BMJ. 2022;377:e069116. doi: 10.1136/bmj-2021-069116.
- 10. Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012 ;367(25):2407-18. doi: 10.1056/NEJMoa1205511.
- 11. Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018;15(12):757-69. doi: 10.1038/s41569-018-0098-5.
- 12. Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018;15(12):757-69. doi: 10.1038/s41569-018-0098-5.
- 13. Lamb YN. Rosuvastatin/Ezetimibe: A Review in hypercholesterolemia. Am J Cardiovasc Drugs. 2020;20(4):381-92. doi: 10.1007/s40256-020-00421-1.
- 14. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: Executive summary: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168- 209. doi: 10.1016/j.jacc.2018.11.002.
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.
Ethical Statement
Bu çalışmanın, özgün bir çalışma olduğunu; çalışmanın hazırlık, veri toplama, analiz ve bilgilerin sunumu olmak üzere tüm aşamalarından bilimsel etik ilke ve kurallarına uygun davrandığımı; bu çalışma kapsamında elde edilmeyen tüm veri ve bilgiler için kaynak gösterdiğimi ve bu kaynaklara kaynakçada yer verdiğimi; kullanılan verilerde herhangi bir değişiklik yapmadığımı, çalışmanın Committee on Publication Ethics (COPE)' in tüm şartlarını ve koşullarını kabul ederek etik görev ve sorumluluklara riayet ettiğimi beyan ederim. Herhangi bir zamanda, çalışmayla ilgili yaptığım bu beyana aykırı bir durumun saptanması durumunda, ortaya çıkacak tüm ahlaki ve hukuki sonuçlara razı olduğumu bildiririm.
Supporting Institution
erciyes üniversitesi tıp fakültesi
References
- 1. Cornec-Le Gall E, Alam A, Perrone RD. Autosomal dominant polycystic kidney disease. Lancet. 2019;393(10174):919-35. doi: 10.1016/S0140-6736(18)32782-X.
- 2. Pei Y, Obaji J, Dupuis A, Paterson AD, Magistroni R, Dicks E, et al. Unified criteria for ultrasonographic diagnosis of ADPKD. J Am Soc Nephrol. 2009 Jan;20(1):205-12. doi: 10.1681/ASN.2008050507.
- 3. Kim DY, Park JH. Genetic mechanisms of ADPKD. Adv Exp Med Biol. 2016;933:13-22. doi: 10.1007/978-981-10-2041-4_2.
- 4. Belibi FA, Edelstein CL. Unified ultrasonographic diagnostic criteria for polycystic kidney disease. J Am Soc Nephrol. 2009;20(1):6-8. doi: 10.1681/ASN.2008111164.
- 5. Chebib FT, Perrone RD, Chapman AB, Dahl NK, Harris PC, Mrug M, et al. Practical guide for treatment of rapidly progressive ADPKD with Tolvaptan. J Am Soc Nephrol. 2018 Oct;29(10):2458-70. doi: 10.1681/ASN.2018060590.
- 6. Zhan S, Tang M, Liu F, Xia P, Shu M, Wu X. Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events. Cochrane Database Syst Rev. 2018;11(11):CD012502. doi: 10.1002/14651858.CD012502.pub2.
- 7. Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL 2nd, Goldstein LB, et al. American Heart Association Clinical Lipidology, Lipoprotein, Metabolism and Thrombosis Committee, a Joint Committee of the Council on Atherosclerosis, Thrombosis and Vascular Biology and Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019 Feb;39(2):e38-e81. doi: 10.1161/ATV.0000000000000073.
- 8. Watkins PB, Lewis JH, Kaplowitz N, Alpers DH, Blais JD, Smotzer DM, et al. Clinical pattern of Tolvaptan-Associated liver Injury in subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database. Drug Saf. 2015;38(11):1103-13. doi: 10.1007/s40264-015-0327-3.
- 9. Khan SU, Yedlapati SH, Lone AN, Hao Q, Guyatt G, Delvaux N, Bekkering GET, et al. PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: a systematic review and network meta-analysis. BMJ. 2022;377:e069116. doi: 10.1136/bmj-2021-069116.
- 10. Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012 ;367(25):2407-18. doi: 10.1056/NEJMoa1205511.
- 11. Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018;15(12):757-69. doi: 10.1038/s41569-018-0098-5.
- 12. Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018;15(12):757-69. doi: 10.1038/s41569-018-0098-5.
- 13. Lamb YN. Rosuvastatin/Ezetimibe: A Review in hypercholesterolemia. Am J Cardiovasc Drugs. 2020;20(4):381-92. doi: 10.1007/s40256-020-00421-1.
- 14. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: Executive summary: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168- 209. doi: 10.1016/j.jacc.2018.11.002.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Olgu Sunumu |
| Authors | |
| Publication Date | December 5, 2023 |
| Acceptance Date | November 13, 2023 |
| Published in Issue | Year 2023 Volume: 8 Issue: 4 |
