Keywords
non Kidney Diseases
Diabetic
IgA nephropathy
Cardiovascular Risk Factors
dapagliflozin
glomerulonephritis
proteinuria
How to Cite
Abstract
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are innovative therapies that have shown benefits beyond glycemic control. Experience and recently published clinical studies have confirmed its usefulness for the prevention of adverse renal and cardiovascular outcomes, therefore its benefits should be extrapolated to different populations outside of type 2 diabetes mellitus.
Purpose: to present and describe the use of dapagliflozin in five patients with IgA Nephropathy.
Case presentation: 5 cases of patients with non-diabetic chronic kidney disease are described, with multiple cardiovascular comorbidities, diagnosis confirmed by biopsy of IgA nephropathy, receiving usual therapy with RAS blockade, steroids according to the case criteria and management of comorbidities. In whom, due to persistence of albuminuria, dapagliflozin was added, with which a variable reduction in albuminuria values ??was obtained over time.
Discussion and conclusion: the use of dapagliflozin was associated with a reduction in albuminuria levels in patients with IgA nephropathy, similar to that reported in studies such as DAPA-CKD. No comments can be made in relation to renal evolution and mortality due to the short follow-up time, for this reason, it is necessary in our environment to strengthen the regulations and addition to the management guidelines of these therapies in scenarios other than diabetes mellitus.
References
Vallon V, Verma S. Effects of SGLT2 Inhibitors on Kidney and Cardiovascular Function. Annu Rev Physiol. 2021;83:503-28. https://doi.org/10.1146/annurev-physiol-031620-095920
Rico-Fontalvo J, Daza-Arnedo R, Cardona-Blanco MX, Leal-Martínez V, Abuabara-Franco E, Pajaro-Galvis N, et al. SGLT2 Inhibitors and nephroprotection in diabetic kidney disease: From mechanisms of action to the latest evidence in the literature. J Clin Nephrol. 2020;4(1):44-55.
Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28. https://doi.org/10.1056/NEJMoa1504720
Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-57. https://doi.org/10.1056/NEJMoa1611925
Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-57. https://doi.org/10.1056/NEJMoa1812389
Fontalvo JE. Guía de práctica clínica para la enfermedad renal diabética. Rev Colomb Nefrol. 2021;8(2). https://doi.org/10.22265/acnef.8.2.561
Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-24. https://doi.org/10.1056/NEJMoa2022190
Solomon SD, McMurray JJ, Claggett B, de Boer RA, DeMets D, Hernandez AF, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022;387(12):1089-98. https://doi.org/10.1056/NEJMoa2206286
Heerspink HJ, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-46. https://doi.org/10.1056/NEJMoa2024816
McMurray JJ, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. https://doi.org/10.1056/NEJMoa1911303
Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJ, Charytan DM, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-306. https://doi.org/10.1056/NEJMoa1811744
Wheeler DC, Toto RD, Stefánsson BV, Jongs N, Chertow GM, Greene T, et al. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy. Kidney Int. 2021;100(1):215-24. https://doi.org/10.1016/j.kint.2021.03.033
Rovin BH, Caster DJ, Cattran DC, Gibson KL, Hogan JJ, Moeller MJ, et al. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(2):281-95. https://doi.org/10.1016/j.kint.2018.11.008
McQuarrie EP, Gillis KA, Mark PB. Seven suggestions for successful SGLT2i use in glomerular disease - a standalone CKD therapy? Curr Opin Nephrol Hypertens. 2022;31(3):272-7. https://doi.org/10.1097/MNH.0000000000000786
Robert T, Cambier A, Hertig A. Intensive Supportive Care plus Immunosuppression in IgA Nephropathy. N Engl J Med. 2016;374(10):991. https://doi.org/10.1056/NEJMc1600141
Palmer B, Clegg D. Kidney Protective Effects of SGLT2 Inhibitors. Clin J Am Soc Nephrol CJASN. 2022:CJN.09380822. https://doi.org/10.2215/CJN.09380822
Gul W, Naem E, Elawad S, Elhadd T. Successful use of the sodium-glucose co-transporter-2 inhibitor dapagliflozin in patients with renal transplant and diabetes: a case series and literature review. Cardiovasc Endocrinol Metab. 2021;10(4):222-4. https://doi.org/10.1097/XCE.0000000000000246
Pollack R, Cahn A. SGLT2 Inhibitors and Safety in Older Patients. Heart Fail Clin. 2022;18(4):635-43. https://doi.org/10.1016/j.hfc.2022.03.002
Empa-Kidney Collaborative Group. Design, recruitment, and baseline characteristics of the EMPA-KIDNEY trial. Nephrol Dial Transplant. 2022;37(7):1317-29. https://doi.org/10.1093/ndt/gfac040
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2022 Revista Colombiana de Endocrinología, Diabetes & Metabolismo