Hall Victoria, Kwong Jason, Johnson Douglas, Ekinci Elif Ilhan
General Medicine, Austin Health, Heidelberg, Victoria, Australia.
Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
BMJ Case Rep. 2017 May 22;2017:bcr-2017-219335. doi: 10.1136/bcr-2017-219335.
We describe an adverse outcome in a 70-year-old man with type 2 diabetes mellitus treated with sodium-glucose cotransporter type 2 (SGLT2) inhibitor dapagliflozin. SGLT2 inhibitors act in the proximal tubules to prevent glucose reabsorption and induce urinary glucose excretion, they have been associated with increased risk of urinary tract infection (UTI). Our patient presented to hospital with septicaemia with positive urine and blood cultures on the background of two previous UTIs occurring post commencement of dapagliflozin in the community. Renal tract ultrasound in hospital revealed incomplete bladder emptying with evidence of urinary stasis, and a postvoid residual volume of 180 mL. His dapagliflozin was ceased, and he has had no further episodes of UTI. This case suggests there may be an increased risk of UTI in patients prescribed SGLT2 inhibitors who also have evidence of bladder outlet obstruction-caution is advised in the prescribing of SGLT2 inhibitors in this setting.
我们描述了一名70岁2型糖尿病男性患者在使用钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂达格列净治疗时出现的不良结局。SGLT2抑制剂作用于近端肾小管,以防止葡萄糖重吸收并诱导尿糖排泄,它们与尿路感染(UTI)风险增加有关。我们的患者因败血症入院,尿液和血液培养呈阳性,其背景是在社区开始使用达格列净后发生了两次UTI。住院期间的肾脏超声检查显示膀胱排空不全,有尿潴留迹象,残余尿量为180毫升。他停用了达格列净,此后未再发生UTI。该病例表明,在同时有膀胱出口梗阻证据的患者中,处方SGLT2抑制剂可能会增加UTI风险——在这种情况下,建议在处方SGLT2抑制剂时谨慎行事。