Aquaretic Agents: Whats Beyond the Treatment of Hyponatremia?

Abstract

Unlike the more commonly used diuretics, aquaretic agents can induce an increase in urinary volume without incurring a loss of electrolytes. These molecules belong to a family of vasopressin receptor antagonists, V2 in particular, that regulate optional renal water re-absorption via the synthesis and expression of aquaporin-2. In view of their properties, they have become the agent of choice in the treatment of hyponatremic states with water retention, and different studies have demonstrated that they are more effective and practical to use than other traditional approaches in the treatment of diseases such as cirrhosis-related ascites, SIADH and, above all, heart failure. However, the future probably holds the promise of new and unexpected applications for this type of drug in the treatment of several conditions, including polycystic kidney and glomerular disease, glaucoma and Meniere's syndrome.

Aqueous Extract of <i>Flueggea leucopyrus</i> Increases Urine Output in Rats

“…Of these, V2 receptors are mainly found in the collecting tubules of kidney and are involved in free water reabsorption [20,21]. Aquaretics antagonize AVP effect by acting via V2 receptors and thereby retard the free water absorption [22]. Currently synthetic aquaretics such as tolvaptan, lixivaptan and conivaptan and natural aquaretics: Solidaginis virgaurea herba, Betulae folium, Ononidis radix, Graminis rhizoma are therapeutically used [19,22].…”

“…Aquaretics antagonize AVP effect by acting via V2 receptors and thereby retard the free water absorption [22]. Currently synthetic aquaretics such as tolvaptan, lixivaptan and conivaptan and natural aquaretics: Solidaginis virgaurea herba, Betulae folium, Ononidis radix, Graminis rhizoma are therapeutically used [19,22]. Interestingly, diuretics cannot be used as a treatment for hyponatreamia.…”

Nephro-oncology: a link in evolution

“…Several studies have demonstrated the effectiveness in the treatment of pathological conditions such as cirrhosis, SIADH and heart failure. 17 AVP is also involved in cellular proliferation of breast, pulmonary and pancreatic cancers. 18 Renal cancer may synthesize and express the V2-receptor, resulting in a proliferative effect in CAKI-2 and A498 cell lines.…”

Papel de los vaptanes en el tratamiento de la hiponatremia

“…En la misma década se inició la cuantificación rutinaria del sodio en el suero. La aproximación fisiopatológica fue que el aumento de la AVP plasmática se producía como consecuencia de un incremento de los estímulos no osmóticos presentes en gran parte de los cuadros de hiponatremia [10][11][12][13][14][15][16][17][18][19][20] . No fue hasta 20 años más tarde que se determinó dicha hormona por radioinmunoensayo, confirmándose, en efecto, que en la mayor parte de las situaciones de hiponatremia las concentraciones plasmáticas de AVP se hallaban elevadas o inadecuadas para la situación de hipoosmolalidad plasmática 10,11 .…”