바소프레신 제2수용체 길항제의 임상 적용

Abstract

Hyponatremia results from a relative excess of total body water compared with the sodium content. Except for primarypolydipsia, vasopressin activation plays a major role in pathogenesis of water retention. Consequently, the increase ofsolute-free water clearance by inactivating vasopressin action would be a more reasonable therapeutic approach than theaddition of sodium. The V2 vasopressin receptor is mainly localized to the collecting ducts in the kidney and causes waterreabsorption via water channels. Selective V2 receptor antagonists or vaptans were recently introduced to clinical practices andmay be useful for correcting dilutional hyponatremia. Clinical trials have shown that vaptans are effective in increasing the serumsodium concentration in patients with syndrome of inappropriate anti-diuresis and congestive heart failure and that they might besafe as long as patients are allowed free accesses to water. However, the indications for using vaptans need to be more refined, andthe question of their long-term cost-effectiveness should be answered. In addition, the potential roles of vaptans in amelioratingthe growth of cysts in polycystic kidney disease, saving diuretics in edematous disorders, and retarding the progression ofchronic kidney disease are being explored.