Acute Kidney Injury Due to Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease Treated With Tolvaptan: A Case Report.

A 61-year-old asymptomatic female with autosomal dominant polycystic kidney disease (ADPKD) on tolvaptan therapy was hospitalized for acute kidney injury (AKI). Nephrolithiasis had already been diagnosed; however, the patient had not undergone any interventions. She also presented with hyponatremia possibly caused by overhydration. Because the estimated glomerular filtration rate (eGFR) decline was significantly higher than the predicted rate, we considered a possible case of postrenal AKI and examined computed tomography (CT), which revealed left hydronephrosis with a 9.4-mm ureteric stone at the level of L3/L4. We restricted fluid intake, which resulted in an increase in sodium levels. She was treated with transurethral lithotripsy (TUL) twice, which successfully improved her kidney function. Although the serum sodium levels increase because of aquaresis in almost all patients treated with tolvaptan, our case was unique in that the patient presented with hyponatremia. We should pay more attention to the periodical follow-up of nephrolithiasis in addition to the increase in total kidney volume and decide the appropriate time to treat nephrolithiasis depending on the case. We should also keep in mind that ADPKD patients have a high frequency of nephrolithiasis and, even if asymptomatic, investigate urinary tract obstruction and hydronephrosis in case of AKI.