The delay of tolvaptan-induced liver injury in an autosomal dominant polycystic kidney disease (ADPKD) patient: A case report

Case presentation: Tolvaptan has been administrated in a 61-year-old man with autosomal dominant polycystic kidney disease (ADPKD) for 11 weeks before the detection of liver dysfunction. At four weeks after the discontinuation of tolvaptan therapy, his liver dysfunction temporarily worsened. Abdominal imaging showed no sign of liver cirrhosis and biliary tract diseases. He received ursodeoxycholic acid (UDCA) with the discontinuation of the previous medication. His transaminase levels improved to levels within the normal range four months after the discontinuation of tolvaptan therapy. He was diagnosed with drug-induced liver injury associated with tolvaptan, based on the liver biopsy findings. Our case suggests that it is highly important to carefully monitor liver function in order to recognize early hepatic side effects in ADPKD patients under tolvaptan therapy. We also need to recognize the long-term effect of tolvaptan-induced liver disease after the discontinuation of tolvaptan therapy.