Osmotic Nephrosis and Acute Kidney Injury Associated With SGLT2 Inhibitor Use: A Case Report.

Abstract

We report a case of a patient who developed dialysis-requiring acute kidney injury (AKI) after the use of canagliflozin. A 66-year-old man with type 2 diabetes who was recovering from left knee septic arthritis at a rehabilitation facility was admitted with oliguric AKI 5 days after starting treatment with canagliflozin, an inhibitor of sodium/glucose cotransporter 2 (SGLT2). The patient presented with hematuria, non-nephrotic-range proteinuria, and serum creatinine level of 6.8 (baseline, 1.1-1.3) mg/dL. There was no recent use of radiocontrast agents or exposure to other nephrotoxins. The patient subsequently required hemodialysis. Due to recent antibiotic use (ampicillin-sulbactam), acute interstitial nephritis was considered in the differential diagnosis. Kidney biopsy was performed, which showed the presence of osmotic nephropathy. The patient's kidney function returned to baseline after 2 weeks of hemodialysis. This case provides evidence of an association of osmotic nephropathy with the use of canagliflozin and discusses potential mechanisms. We recommend kidney biopsy for cases of severe AKI associated with SGLT2 inhibitors to better understand the relationship of this complication with the use of this class of medications.

• Authors: Gautam Phadke, Amit Kaushal, Dean R Tolan, Kai Hahn, Thomas Jensen, Petter Bjornstad, Carlos Roncal-Jimenez, Ana Andres Hernando, Miguel A Lanaspa, Mariam Priya Alexander, Aleksandra Kukla, Richard J Johnson
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 76 Issue 1 Pg. 144-147 (07 2020) ISSN: 1523-6838 [Electronic] United States
• PMID: 32387022 (Publication Type: Case Reports)
• Copyright: Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Diuretics, Osmotic
• Sodium-Glucose Transporter 2 Inhibitors
• Canagliflozin

Topics

• Acute Kidney Injury (chemically induced, diagnostic imaging, metabolism)
• Aged
• Canagliflozin (adverse effects)
• Diuretics, Osmotic (adverse effects)
• Humans
• Male
• Nephrosis (chemically induced, diagnostic imaging, metabolism)
• Sodium-Glucose Transporter 2 Inhibitors (adverse effects)