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This Article Full Text Full Text (PDF) All Versions of this Article: CJN.00790209v1 4/6/1140    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Torres, V. E. Articles by Grantham, J. J. PubMed PubMed Citation Articles by Torres, V. E. Articles by Grantham, J. J.

A Case for Water in the Treatment of Polycystic Kidney Disease

Vicente E. Torres^*, Lise Bankir, and Jared J. Grantham

^* Mayo Clinic College of Medicine, Rochester, Minnesota; Institut National de la Santé et de la Recherche Medicale, UMRS 872, Centre de Recherche des Cordeliers, Paris, France; University of Kansas Medical Center, Kansas City, Kansas

Correspondence: Vicente E. Torres, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905. Phone: 507-266-0541; Fax: 507-266-9315; E-mail: torres.vicente{at}mayo.edu

Autosomal dominant polycystic disease (ADPKD) is an inherited disorder characterized by the development within renal tubules of innumerable cysts that progressively expand to cause renal insufficiency. Tubule cell proliferation and transepithelial fluid secretion combine to enlarge renal cysts, and 3'-5'-cyclic adenosine monophosphate (cAMP) stimulates that growth. The antidiuretic hormone, arginine vasopressin (AVP), operates continuously in ADPKD patients to stimulate the formation of cAMP, thereby contributing to cyst and kidney enlargement and renal dysfunction. Studies in animal models of ADPKD provide convincing evidence that blocking the action of AVP dramatically ameliorates the disease process. In the current analysis, the authors reason that increasing the amount of solute-free water drunk evenly throughout the day in patients with ADPKD and normal renal function will decrease plasma AVP concentrations and mitigate the action of cAMP on the renal cysts. Potential pitfalls of increasing fluid intake in ADPKD patients are considered, and suggestions for how physicians may prudently implement this therapy are offered.