Discussion
urinary tract infections, MCD, non-diabetic glomerulonephritis, FSGS, IgA nephropathy, proteinuria, glomerulonephritis, HCV-related glomerulonephritis, diabetic kidney disease, hypoglycemic, lupus nephritis, albuminuria
URINARY TRACT INFECTIONS, ASYMPTOMATIC BACTERIURIA, DIABETIC KIDNEY DISEASE, IGA NEPHROPATHY, GLOMERULONEPHRITIS, DIABETES MELLITUS, CHRONIC GLOMERULONEPHRITIS, GENITAL INFECTIONS, LUPUS NEPHRITIS
In this pilot randomized controlled trial, we assessed the effect of empagliflozin on urine protein excretion and preservation of kidney function as measured eGFR, in patients with non-diabetic glomerulonephritis. Empagliflozin 25 mg once daily efficacy was tested against standard treatment (RAAS blockers and immunosuppression) alone (placebo group). There were no significant differences between both groups as age and sex distribution.Causes of glomerulonephritis were comparable in both groups. The most common causes of proteinuria in our cohort were MCD, FSGS, lupus nephritis and HCV-related glomerulonephritis.The use of empagliflozin at a dose of 25 mg once daily, resulted in marked improvement in proteinuria as compared to the placebo (ACEi or ARBs plus immunosuppression alone. Empagliflozin had a favorable effect on preservation of kidney functions (eGFR and serum creatinine) as compared to placebo. However, this was statistically non-significant.Reduction of proteinuria and preservation of kidney function are the two main goals of treatment of chronic glomerulonephritis. Sodium–glucose co-transporter 2 (SGLT2) inhibitors were successfully endorsed by guidelines as add on therapy in the management type 2 Diabetes mellitus. In large clinical trials, SGLT inhibitors demonstrated favorable effects on preservation of kidney function in patients with CKD.There were no reported cases of genital infections, related to the use of empagliflozin in our cohort. some cases of asymptomatic bacteriuria were reported before and after treatment with no statistical significance. Previous studies have shown that the prevalence of urinary tract infections in patients treated with empagliflozin was not higher than control groups [Large multicenter studies have shown the favorable effects of the SGLT inhibiting agents on albuminuria and kidney function preservation. In the EMPA-REG OUTCOME trial, empagliflozin 10–25 mg/day reduced the incidence of the traditional renal composite outcome of doubling of creatinine by 46% [In a subgroup analysis of the DAPA-CKD trial, dapagliflozin use in patients with IgA nephropathy was associated with favorable effect on eGFR [There were no hypoglycemic episodes reported in our cohort. Mean random blood glucose (RBG) level among the empagliflozin treated group was 91.64 ± 9.54 mg/dl before treatment versus 91.56 ± 8.13 mg/dl after treatment, with no statistically significant difference (The strength of our study is that it is one of the earliest studies to assess empagliflozin in patient with glomerulonephritis other than diabetic kidney disease.