Abstract
Normally the tonicity of the extracellular fluid is maintained within a narrow range, favorable to cellular well-being, by the osmoregulatory system. The kidney plays a central role in water homeostasis, guided by the antidiuretic hormone, arginine vasopressin, which is secreted by the posterior pituitary in response to changes in plasma tonicity. The kidney preserves water when it is scarce by concentrating the urine and eliminates excess water by urinary dilution. Chronic kidney disease impairs the ability to concentrate and dilute the urine maximally, restricting the responses to altered water intake and losses, making patients with kidney disease susceptible to hyponatremia and hypernatremia. Impaired concentrating ability also leads to increased vasopressin levels, which increase glomerular filtration rate. Vasopressin-induced hyperfiltration may be maladaptive, leading to kidney hypertrophy and accelerating the loss of renal function. Elevated vasopressin levels are particularly harmful in autosomal dominant polycystic kidney disease (ADPKD) because vasopressin promotes cyst formation. Vasopressin antagonists have been shown to retard progression of this condition. Many studies are currently underway testing the impact of increased water intake on the progression of ADPKD and other kidney diseases.
Published Version
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