钠-葡萄糖协同转运蛋白-2抑制剂治疗新月体IgA肾病伴快速进展性肾小球肾炎患者蛋白尿的缓解:偶然关系还是因果关系?

J. C. De La Flor Merino, Jacqueline Apaza Chávez, Francisco Valga Amado, Francisco Díaz Crespo, P. Justo Avila, A. Marschall, Michael Cieza Terrones, Patricia Núñez Ramos, E. Ruiz Cícero
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引用次数: 1

摘要

新月体IgA肾病(IgAN)伴快速进展性肾小球肾炎(RPGN)通常与肾功能快速下降有关。到目前为止,新月体IgAN的特异性治疗方法仍然未知。越来越多的证据表明,钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)可能在肾小球疾病的标准治疗中发挥作用。然而,尚不清楚在特定肾小球疾病的自然史上,SGLT-2i在什么时候是有益的。我们报告了一名新月体IgAN患者的临床和组织学特征,该患者表现为RPGN,接受了强化免疫抑制和肾脏替代治疗(RRT)。第三个月时,患者的肾功能出现了显著改善。在这一点上,我们决定除了肾素-血管紧张素系统(RAS)阻滞剂外,还开始使用达格列嗪,这是基于其已证实的肾脏益处,如减缓肾功能下降速度和减少蛋白尿。在第8个月,患者的肾功能从血清Cr 6.07逐渐改善到2.1 mg/dL;尿白蛋白与肌酐比值(UACR)从5655mg/g下降到200mg/g。SGLT-2i在原发性和继发性非糖尿病肾小球疾病中的应用似乎很有前景。为更全面地了解SGLT-2i在非糖尿病肾小球疾病中的作用机制,积累更多的证据是至关重要和必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Remission of Proteinuria in a Patient Affected by Crescentic IgA Nephropathy with Rapidly Progressive Glomerulonephritis Treated by Sodium-Glucose Cotransporter-2 Inhibitors: Casual or Causal Relationship?
Crescentic IgA nephropathy (IgAN) with rapidly progressive glomerulonephritis (RPGN) is often associated with rapidly declining kidney function. Up to this date, specific therapy for crescentic IgAN is still unknown. Accumulating evidence suggests that sodium-glucose co-transporter-2 inhibitors (SGLT-2i) may have a role in standard therapy of glomerular diseases. However, it is unclear at what point in the natural history of specific glomerular diseases SGLT-2i can be beneficial. We report the clinical and histological features of a patient with crescentic IgAN that presented as an RPGN, who received intensive immunosuppression and renal replacement therapeutic (RRT). At the third month, the patient presented with significant improvement in his kidney function. At that point, we decided to start dapagliflozin in addition to his renin-angiotensin system (RAS) blocker, basing our decision on its proven renal benefits such as slowing the rate of decline in kidney function and reducing albuminuria. At the eighth month, the patient’s renal function gradually improved from serum Cr of 6.07 to 2.1 mg/dL; and urine albumin to creatinine ratio (UACR) declined from 5655 mg/g to 200 mg/g. The use of SGLT-2i in primary and secondary nondiabetic glomerular disease appears promising. It is crucial and necessary to accumulate more evidence for a more complete understanding of the mechanisms of the actions of SGLT-2i in non-diabetic glomerular disease.
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