Hyponatremia, Arginine Vasopressin Dysregulation, and Vasopressin Receptor Antagonism

Abstract

Hyponatremia is often associated with arginine vasopressin (AVP) dysregulation that is regulated by the hypothalamo-neurohypophyseal tract in response to changes in plasma osmolality, commonly in patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Potentially lethal complications of hyponatremia most frequently involve the central nervous system and include anorexia, fatigue, lethargy, delirium, seizures, hypothermia and coma, and require prompt treatment. Chronic hyponatremia also complicates patient care and is associated with increased morbidity and mortality, particularly among patients with congestive heart failure. Conventional treatments for hyponatremia (e.g. fluid restriction, diuretic treatment, and sodium replacement) may not be effective in all patients and can lead to significant adverse events. Preclinical and clinical trial results have shown that AVP receptor antagonism is a promising approach to the treatment of hyponatremia that directly addresses the effects of increased AVP and consequent decreased aquaresis, the electrolyte-sparing excretion of free water. Agents that antagonize V₂ receptors promote aquaresis and can lead to increased serum sodium. Dual-receptor antagonism, in which both V₂ and V_1A receptors are blocked, may provide additional benefits in patients with hyponatremia.

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2006

Publication date (Print): January 2007

Publication date (Electronic): 19 January 2007

Volume: 26

Issue: 6

Pages: 579-589

Affiliations

^aDepartments of Internal Medicine, Division of Nephrology, University of Missouri-Columbia School of Medicine, and Harry S. Truman VA Medical Center, Columbia, Mo., ^bState University of New York, Brooklyn, N.Y., and ^cUniversity of Arizona Diabetes Center, Tucson, Ariz., USA

Article

Publisher ID: 98028 Other ID: Am J Nephrol 2006;26:579–589

DOI: 10.1159/000098028

PubMed ID: 17170524

Copyright statement: © 2006 S. Karger AG, Basel

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Page count

Figures: 2, Tables: 1, References: 85, Pages: 11

Product

Self URI (application/pdf): https://www.karger.com/Article/Pdf/98028

Self URI (text/html): https://www.karger.com/Article/FullText/98028

Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology

Categories

Subject: In-Depth Topic Review