Phd Ceremony Ms. W.E. Boertien :Vasopressin in chronic kidney disease and its effects in autosomal dominant polycystic kidney disease

Vasopressin, the antidiuretic hormone, is an important regulator of the human water homeostasis. Besides this important function is vasopressin also associated with kidney function decline as shown in this thesis. First we show that baseline vasopressin, measured as copeptin (a part of the precursor of vasopressin), is associated with kidney function decline in patients with diabetes and in patients with autosomal dominant polycystic kidney disease (ADPKD). This result suggests that measuring copeptin can help to select patients with the most progressive disease and it suggests that lowering vasopressin levels might prevent kidney function decline in these patients. In the second part of this thesis we studied the effects of stimulating (by a water deprivation test) or blocking (by a vasopressin receptor antagonist) the vasopressin v2 receptor in the kidney in patients with ADPKD. In ADPKD patients with normal kidney function, the concentrations of copeptin and vasopressin were significantly elevated during the water deprivation test, as compared to healthy controls. Blocking the receptor leads probably to a lower glomerular pressure, and leads to a lower excretion of urinary damage markers, even in patients with an impaired kidney function.