Efficacy of tolvaptan in a patient with right-sided heart failure and renal dysfunction refractory to diuretic therapy.

The use of loop diuretics has been shown to deteriorate renal dysfunction and is associated with a poor prognosis in patients with heart failure (HF). Tolvaptan, a vasopressin V2-receptor antagonist, has been reported to be effective in treating HF due to its potent effects of water diuresis and is expected to improve fluid retention without adversely affecting renal function. The present case is a 77-year-old man with pulmonary hypertension associated with chronic pulmonary artery thrombosis and old pulmonary tuberculosis who developed worsening right-sided HF with marked fluid retention and renal dysfunction. In this case, tolvaptan was effective in improving HF without deteriorating the patient's renal dysfunction. <Learning objective: Tolvaptan is effective in treating patients with right-sided heart failure associated with marked fluid retention and renal dysfunction who are refractory to loop diuretics and can improve and control heart failure symptoms without worsening renal dysfunction.>.