Pleros Christos, Stamataki Elisavet, Papadaki Antonia, Damianakis Nikolaos, Poulidaki Rafaela, Gakiopoulou Charikleia, Tzanakis Ioannis
Department of Nephrology, General Hospital of Chania, Meletiou Metaxaki 25, 73131, Chania, Crete, Greece.
Division of Pathology, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
CEN Case Rep. 2018 May;7(1):17-20. doi: 10.1007/s13730-017-0283-0. Epub 2017 Nov 10.
A 50-year-old man with type II diabetes, hypertension and dyslipidemia, presented with non-oliguric acute kidney injury (AKI) and anemia. Renal biopsy showed acute tubular necrosis (ATN) with extensive cytoplasmic vacuolization and areas of tubulitis. These findings were ultimately attributed to dapagliflozin, which he started 3 months earlier due to poor glycemic control. ATN with similar microscopic findings has been described with larger doses of dapagliflozin in non-clinical trials. Our patient was started on dialysis and remained dialysis-dependent for 4 weeks while his renal function improved gradually thereafter. Sixteen months after initial presentation he is being followed as an outpatient with chronic kidney disease (CKD) stage 3a. Dapagliflozin belongs to a novel class of antidiabetic drugs for which clinical trials show great beneficial effects on cardiovascular outcomes and glycemic control and as with many new drugs, their safety profile is being constantly revised. We report the first biopsy-proven ATN caused by dapagliflozin. Great caution together with continuous monitoring of renal function is advised when implementing SGLT-2 inhibitors in clinical practice.
一名患有2型糖尿病、高血压和血脂异常的50岁男性，出现非少尿型急性肾损伤（AKI）和贫血。肾活检显示急性肾小管坏死（ATN），伴有广泛的细胞质空泡化和肾小管炎区域。这些发现最终归因于达格列净，他因血糖控制不佳于3个月前开始使用该药。在非临床试验中，使用较大剂量达格列净时曾描述过具有类似显微镜下表现的ATN。我们的患者开始接受透析，并在4周内一直依赖透析，此后肾功能逐渐改善。初次就诊16个月后，他作为门诊患者接受慢性肾脏病（CKD）3a期的随访。达格列净属于一类新型抗糖尿病药物，临床试验表明其对心血管结局和血糖控制有很大益处，与许多新药一样，它们的安全性概况也在不断修订。我们报告了首例经活检证实由达格列净引起的ATN。在临床实践中使用钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂时，建议极度谨慎并持续监测肾功能。
