PMC5337466_01
Immunohistochemistry of IgG1, IgG2, IgG3, and IgG4 in Case 1 (magnified 200x). IgG2 and IgG4 were strongly stained in the glomeruli.
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IgG subclasses were also stained. IgG1, and IgG3 were negative in the glomeruli, but IgG2 and IgG4 were strongly positive (Fig. 1).
A: Immunohistochemistry of AQP-2 (brown) in Case 1, a tolvaptan responder (magnified 100x). B: Immunohistochemistry of AQP-2 (brown) in Case 2, a tolvaptan non-responder (magnified 100x). The level of AQP-2 immunostaining was weaker than in Case 1.
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The expression of AQP-2 was lower than in Case 1 (Fig. 2B).
Clinical course and serial changes in the urine volume and urinary protein excretion in Cases 1 (blue) and 2 (red) after initiation of tolvaptan.
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However, the urine volume and protein excretion showed little change over the next 7 days (Fig. 3, red line). AQP-2 level and osmolality remained low (0.82 ng/mgCre and 160 mOsm/kgH2O, respectively). After the initiation of PSL, the urine volume increased to 1,800 mL/day by the 14th day and remained at that level until the 56th day (Fig. 3, red line). The urinary protein excretion also decreased to 0.9 g/day by the 56th day (Fig. 3, red bar).
Changes in the serum sodium levels in Case 1 (tolvaptan responder) and Case 2 (tolvaptan non-responder). There was no excess increase in the serum sodium levels in either case.
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The changes in the serum sodium level are shown in Fig. 4.
PMC5337466_02
A: Immunohistochemistry of AQP-2 (brown) in Case 1, a tolvaptan responder (magnified 100x). B: Immunohistochemistry of AQP-2 (brown) in Case 2, a tolvaptan non-responder (magnified 100x). The level of AQP-2 immunostaining was weaker than in Case 1.
1349-7235-56-0191-g002.jpg
PMC5337466_02_1349-7235-56-0191-g002.jpg
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The expression of AQP-2 was lower than in Case 1 (Fig. 2B).
Clinical course and serial changes in the urine volume and urinary protein excretion in Cases 1 (blue) and 2 (red) after initiation of tolvaptan.
1349-7235-56-0191-g003.jpg
PMC5337466_02_1349-7235-56-0191-g003.jpg
g003
However, the urine volume and protein excretion showed little change over the next 7 days (Fig. 3, red line). AQP-2 level and osmolality remained low (0.82 ng/mgCre and 160 mOsm/kgH2O, respectively). After the initiation of PSL, the urine volume increased to 1,800 mL/day by the 14th day and remained at that level until the 56th day (Fig. 3, red line). The urinary protein excretion also decreased to 0.9 g/day by the 56th day (Fig. 3, red bar).
Changes in the serum sodium levels in Case 1 (tolvaptan responder) and Case 2 (tolvaptan non-responder). There was no excess increase in the serum sodium levels in either case.
1349-7235-56-0191-g004.jpg
PMC5337466_02_1349-7235-56-0191-g004.jpg
g004
The changes in the serum sodium level are shown in Fig. 4.