Empagliflozin
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Acute interstitial nephritis and acute tubular necrosis: case report A 67-year-old woman developed acute interstitial nephritis and acute tubular necrosis related to an SGLT2-inhibitor empagliflozin [route and dosage not stated; time to reaction onset not clearly stated]. The woman presented to a hospital with weakness, dizziness and abdominal pain. Her medical history was significant for hypertension, diabetes mellitus, ischaemic heart disease and peripheral vascular disease. Two months prior the current presentation, she had started receiving empagliflozin for diabetes mellitus. Her concomitant medications included bisoprolol, losartan, amlodipine, sitagliptin and aspirin. Several days following initiation of empgliflozin, she experienced weakness and dizziness and thus her empagliflozin was discontinued. A week prior to the current presentation, her empagliflozin was re-initiated by her cardiologist. She had no recent history of illness, fevers, rash, arthralgias, respiratory symptoms or bone pain and denied exposure to other new medications (including NSAIDS and antibiotics). At the time of the admission, her blood pressure was 165/76mm Hg and rest of the physical examination was unremarkable. The laboratory investigations revealed acute kidney injury (creatinine 3.19 mg/dL, blood urea nitrogen 28 mg/dL and baseline creatinine 0.9 mg/dL). Urinalysis showed a few leukocytes, but no red cells or casts. The urine protein to creatinine ratio was 5160mg of protein per gram creatinine. Her abdominal ultrasonography revealed normal-size kidneys with no hydronephrosis. Immunologic and infectious serologies were unremarkable. She became oligo-anuric over several days and her creatinine level peaked to 9.22 mg/dL and thus haemodialysis was initiated. She started receiving empiric treatment with prednisone and a renal biopsy was performed. The renal biopsy showed four glomeruli on light microscopy and the glomeruli were normocellular. Interstitial infiltrate of lymphocytes and small numbers of eosinophils were also seen along with thining of the renal tubular brush border with intra-tubular necrotic content. Immunofluorescence tests were negative. Based on these findings, a diagnosis of acute interstitial nephritis and acute tubular necrosis secondary to empagliflozin was made. The woman was discharged on a regimen of intermittent haemodialysis and unspecified steroid therapy. Three months later, her urine output and kidney function improved, and she was weaned off dialysis. Bnaya A, et al. Acute interstitial nephritis related to empagliflozin. Nephrology Dialysis Transplantation 35 (Suppl. 3): iii900 abstr. P0580, Jun 2020. Available from: URL: 803520269 http://doi.org/10.1093/ndt/gfaa142.P0580 [abstract]
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Reactions 12 Dec 2020 No. 1834
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