Nephro Nutshell issue 2

This issue marks an update on tolvaptan in various aspects of nephrology.

First section covers about tolvaptan role in syndrome of inappropriate antidiuretic hormone with associated subarachnoid cyst; where it was shown that tolvaptan can be considered as a useful treatment for chronic hyponatremia due to syndrome of inappropriate antidiuretic hormone, especially in patients who do not respond to other treatment options.

Secondly, in a virtual meeting held during Kidney week 2021 from Nov 4^th-7^th, it was shown that tolvaptan treatment is associated with changes in mineral metabolism parameters and increased bone mineral density at the femoral neck in patients with autosomal dominant polycystic kidney disease. Third section covers update in technology; robot-assisted laparoscopic nephroureterectomy is a minimally invasive surgery for upper urinary tract urothelial carcinmoma.

Lastly, long-term treatment with tolvaptan has been shown to decrease blood pressure in patients with autosomal dominant polycystic disease patients which signifies tolvaptan’s beneficial effect on disease progression, a continued natriuretic effect, or both.