Tolvaptan-induced isolated elevation of bilirubin in a patient with Gilbert syndrome

Matthew Nguyen; Beshoy T Yanny; Tai Ld Truong; Hongyu Zhao; Ramy Hanna

doi:10.1177/2050313X231169841

Tolvaptan-induced isolated elevation of bilirubin in a patient with Gilbert syndrome

SAGE Open Med Case Rep. 2023 Apr 29:11:2050313X231169841. doi: 10.1177/2050313X231169841. eCollection 2023.

Authors

Matthew Nguyen¹, Beshoy T Yanny², Tai Ld Truong¹, Hongyu Zhao¹, Ramy Hanna¹

Affiliations

¹ Division of Nephrology, Hypertension & Kidney Transplantation, Department of Medicine, University of California, Irvine Medical Center, Irvine, CA, USA.
² Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.

Abstract

Tolvaptan is the current standard of treatment for autosomal dominant polycystic kidney disease. It operates by acting on V2 receptors and blocks vasopressin interactions, causing a reduction in the rate of renal cyst growth and preserving kidney function. The current known risks of tolvaptan involve a serious liver injury characterized by an elevation in total bilirubin and alanine transaminase and aspartate transaminase levels. In this report, we document a unique liver injury characterized by an elevated bilirubin with normal alanine transaminase and aspartate transaminase levels in a patient who is homozygous for the UGT1A1 consistent with Gilbert syndrome.

Keywords: Gilbert’s syndrome; Tolvaptan; autosomal dominant polycystic kidney disease.

Publication types

Case Reports