Effect of dapagliflozin on eGFR slope in IgA nephropathy based on renal pathological assessment using image analysis software

Abstract

Introduction

Studies have examined the effect of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, on chronic kidney disease (CKD), including immunoglobulin A nephropathy (IgAN). Dapagliflozin decreases albuminuria and slows the decline in estimated glomerular filtration rate (eGFR). However, its renoprotective effects may not be observed in all patients with IgAN in real-world clinical practice. In this study, we aimed to investigate the potential relationship between renal histopathology analyzed using imaging software and the renoprotective effects of dapagliflozin.

Methods

The mesangial matrix fraction (Mes Fx) in patients with IgAN was analyzed using Image-J, an imaging software. The relationships between eGFR slope decline, changes in urinary protein, and the degree of Mes Fx before and after dapagliflozin treatment were investigated.

Results

A significant correlation was evident between the degree of Mes Fx and eGFR slope decline in patients with IgAN. Furthermore, it was suggested that when the Mes Fx exceeded 10 % of the total glomerular surface area, the effect of dapagliflozin in slowing the eGFR decline was unclear.

Conclusions

However, it should be noted that this study has limitations, including the absence of a control group, the small data size, and its pilot study nature. Therefore, it cannot be stated unequivocally that dapagliflozin's efficacy is definitively demonstrated by Mes Fx predictive role.