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Kidney Week

Abstract: FR-PO225

Remission of Tubulointerstitial Nephropathy and Its Correlation to the Reduction of Albuminuria by SGLT2 Inhibitor in Patients with Advanced Stages of Diabetic Kidney Disease

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Sato, Saeko, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Kanozawa, Koichi, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Takayanagi, Kaori, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Aoyagi, Mai, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Sato, Mariko, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Terao, Masaaki, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Hirose, Kento, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Kogure, Yuta, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Hara, Hiroaki, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Shimizu, Taisuke, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Hasegawa, Hajime, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
Background

The aim of this study is to examine the clinical advantages of SGLT2 inhibitor predominantly focusing on the amelioration of tubulo-interstitial nephropathy (TIN) through the prospective clinical study.

Methods

Patients with diabetic kidney disease were enrolled, and the patients were received 50 mg of Iplagliflozin. Their blood and urine were sampled at 0 M as baseline, 1 M and 12 M for measurement of parameters including urine Liver Fatty Acid Binding Protein (L-FABP), urine N-acetyl β-D-glucosaminidase (NAG), urine monocyte chemoattractant protein-1 (MCP-1), urine type IV collagen (T4C), 8-hydroxy-2'- deoxyguanosine (8OHdG) in addition to the regular biochemical parameters.

Results

All enrolled patients (n=25, 57.6 of mean age) showed no significant change in their blood pressure and body mass index during the observation period. Their eGFR was not changed either (57.7±21.3 at 0 M, 56.5±21.9 at 1 M, 58.0±24.4 mL/min at 12 M). Urine albumin-to-Cr ratio (ACR) was significantly reduced at 1 M and maintained until 12 M (median: 298.3 at 0 M, 136.0 at 1 M, 141.5 mg/gCr at 12 M). The reduction of ACR was even significant in xx patients who showed GFR<60 mL/min (median: 298.3 at 0 M vs 111.7 mg/gCr at 1 M, p=0.002). We also examined the correlation between baseline ACR and other parameters by single regression analysis, indicating that TIN-related parameters showed weak correlation (LFABP: R2=0.242, p=0.032, MCP-1: R2=0.252, p=0.029) but T4C and eGFR did not. When the patients were divided into two groups based on the ACR reduction responding to SGLT2 inhibitor by the median value of percent-reduction rate of ACR at 1 M, parameters related to TIN showed significant difference among the two groups (LFABP median: 6.58 vs 3.07 µg/gCr, NAG index median: 9.63 vs 7.19 U/gCr, MCP-1 median: 2.42 vs 1.77 pg/gCr) whereas T4C and eGFR were not different.

Conclusion

SGLT2 inhibitor significantly reduced the albuminuria even in patients with advanced renal damage. In these subjects, the reduction of ACR might be highly involved in the severity and restoring of TIN than glomerular damages.