Management of Diabetes Associated with Nephrotic Syndrome: Therapeutic Potential of Dapagliflozin for Protracted Volume Retention

Toshimi Imai; Tetsu Akimoto; Chiharu Ito; Takahiro Masuda; Daisuke Nagata

doi:10.33393/dti.2015.1410

Authors

Toshimi Imai Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.
Tetsu Akimoto Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.
Chiharu Ito Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.
Takahiro Masuda Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.
Daisuke Nagata Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.

DOI:

https://doi.org/10.33393/dti.2015.1410

Keywords:

nephrotic syndrome, SGLT-2, dapagliflozin, diabetes, furosemide

Abstract

A 48-year-old female was admitted to our hospital presenting with a chief complaint of progressive swelling because of diabetic nephrotic syndrome. Dapagliflozin seemed to play a role in accelerating the patient’s urinary sodium excretion as well as reducing gross fluid retention despite the fact that her nephrotic condition was resistant to furosemide. Our experience emphasizes a potential novel approach to overcoming loop diuretic resistance using this agent among some subsets of type 2 diabetic subjects complicated with severe volume accumulation. We believe that combination treatment consisting of dapagliflozin and furosemide may produce diuretic synergy via sequential nephron blockade. The accumulation of more experience with additional cases similar to ours requires continuous and careful attention.