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Updated: Jul 31, 2025

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Tolvaptan-induced isolated elevation of bilirubin in a patient with Gilbert syndrome
Matthew Nguyen1, Beshoy T Yanny2, Tai Ld Truong1
1Division of Nephrology, Hypertension & Kidney Transplantation, Department of Medicine, University of California, Irvine Medical Center, Irvine, CA, USA.
Abstract:
Tolvaptan is the current standard of treatment for autosomal dominant polycystic kidney disease. It operates by acting on V2 receptors and blocks vasopressin interactions, causing a reduction in the rate of renal cyst growth and preserving kidney function. The current known risks of tolvaptan involve a serious liver injury characterized by an elevation in total bilirubin and alanine transaminase and aspartate transaminase levels. In this report, we document a unique liver injury characterized by an elevated bilirubin with normal alanine transaminase and aspartate transaminase levels in a patient who is homozygous for the UGT1A1 consistent with Gilbert syndrome.
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