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

Imai T, Akimoto T, Ito C, Masuda T, Nagata D - Drug Target Insights (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

Clinical course. On hospital day 12, intravenous furosemide was terminated, while oral furosemide was continued with an increased dose of 300 mg/day, and the patient was discharged on hospital day 16. Note that the levels of BP and serum Cr (sCr) were almost constant during the observation period despite prominent elevation of the daily urine output after the commencement of oral dapagliflozin.
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f1-dti-9-2015-029: Clinical course. On hospital day 12, intravenous furosemide was terminated, while oral furosemide was continued with an increased dose of 300 mg/day, and the patient was discharged on hospital day 16. Note that the levels of BP and serum Cr (sCr) were almost constant during the observation period despite prominent elevation of the daily urine output after the commencement of oral dapagliflozin.

Mentions: Based on the clinical picture and laboratory findings, the patient was thus diagnosed as having nephrotic syndrome due to diabetic nephropathy. Despite treatment with an increased dose of furosemide, given both orally and intravenously, her body weight and daily urine volume remained almost constant, keeping her grossly edematous. She then received treatment with oral dapagliflozin at a dose of 5 mg/day on hospital day 5, which resulted in a remarkable increase in her urine volume as well as the amount of urinary excreted sodium and glucose, with the gradual disappearance of the generalized edema, despite the almost constant levels of her systolic and diastolic BP during the observation period (Fig. 1). Finally, her body weight settled at around 65 kg under the treatment with sodium and fluid restriction and the same dose of dapagliflozin combined with oral furosemide (220 mg/day). At three months of follow-up, she is currently doing well with an HbA1c level of 6.1% despite protracted nephrotic-range proteinuria at approximately 5 g/day.


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

Imai T, Akimoto T, Ito C, Masuda T, Nagata D - Drug Target Insights (2015)

Clinical course. On hospital day 12, intravenous furosemide was terminated, while oral furosemide was continued with an increased dose of 300 mg/day, and the patient was discharged on hospital day 16. Note that the levels of BP and serum Cr (sCr) were almost constant during the observation period despite prominent elevation of the daily urine output after the commencement of oral dapagliflozin.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4644139&req=5

f1-dti-9-2015-029: Clinical course. On hospital day 12, intravenous furosemide was terminated, while oral furosemide was continued with an increased dose of 300 mg/day, and the patient was discharged on hospital day 16. Note that the levels of BP and serum Cr (sCr) were almost constant during the observation period despite prominent elevation of the daily urine output after the commencement of oral dapagliflozin.
Mentions: Based on the clinical picture and laboratory findings, the patient was thus diagnosed as having nephrotic syndrome due to diabetic nephropathy. Despite treatment with an increased dose of furosemide, given both orally and intravenously, her body weight and daily urine volume remained almost constant, keeping her grossly edematous. She then received treatment with oral dapagliflozin at a dose of 5 mg/day on hospital day 5, which resulted in a remarkable increase in her urine volume as well as the amount of urinary excreted sodium and glucose, with the gradual disappearance of the generalized edema, despite the almost constant levels of her systolic and diastolic BP during the observation period (Fig. 1). Finally, her body weight settled at around 65 kg under the treatment with sodium and fluid restriction and the same dose of dapagliflozin combined with oral furosemide (220 mg/day). At three months of follow-up, she is currently doing well with an HbA1c level of 6.1% despite protracted nephrotic-range proteinuria at approximately 5 g/day.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.

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.

No MeSH data available.


Related in: MedlinePlus