Advertisement

CEN Case Reports

, Volume 8, Issue 2, pp 128–133 | Cite as

Two cases of advanced stage rapidly progressive diabetic nephropathy effectively treated with combination therapy including RAS blocker, GLP-1 receptor agonist and SGLT-2 inhibitor

  • Junki Morino
  • Keiji HiraiEmail author
  • Shohei Kaneko
  • Saori Minato
  • Katsunori Yanai
  • Yuko Mutsuyoshi
  • Hiroki Ishii
  • Momoko Matsuyama
  • Taisuke Kitano
  • Mitsutoshi Shindo
  • Akinori Aomatsu
  • Haruhisa Miyazawa
  • Kiyonori Ito
  • Yuichiro Ueda
  • Taro Hoshino
  • Susumu Ookawara
  • Kazuo Hara
  • Yoshiyuki Morishita
Case Report
  • 185 Downloads

Abstract

We herein report two cases of advanced stage rapidly progressive diabetic nephropathy that were effectively treated with combination therapy including renin–angiotensin–aldosterone system (RAS) blocker [angiotensin II receptor blocker (ARB)], glucagon-like peptide-1 (GLP-1) receptor agonist and sodium glucose transporter-2 (SGLT-2) inhibitor. A 30-year-old woman with advanced stage diabetic nephropathy [estimated glomerular filtration rate (eGFR): 20.7 mL/min/1.73 m2; proteinuria: 13.2 g/gCr], showing a rapidly progressive pattern (annual eGFR change: − 60.0 mL/min/1.73 m2/year), had improvement in proteinuria (5.9 g/gCr) and eGFR change (+ 4.3 mL/min/1.73 m2 over 15 weeks) after administration of ARB (irbesartan 25 mg/day), GLP-1 receptor agonist (liraglutide 0.3 mg/day) and SGLT-2 inhibitor (canagliflozin 50 mg/day). A 59-year-old man with advanced stage diabetic nephropathy (eGFR: 32.4 mL/min/1.73 m2; proteinuria: 8.90 g/gCr), showing a rapidly progressive pattern (annual eGFR change: − 21.2 mL/min/1.73 m2/year), had an improvement in proteinuria (0.02 g/gCr) and annual eGFR change (+ 0.1 mL/min/1.73 m2/year) after combination therapy with ARB (olmesartan 40 mg/day), GLP-1 receptor agonist (liraglutide 0.9 mg/day) and SGLT-2 inhibitor (tofogliflozin 10 mg/day). These results suggest that this triple combination therapy has renoprotective effects on advanced stage rapidly progressive diabetic nephropathy.

Keywords

Rapidly progressive diabetic nephropathy Angiotensin II receptor blocker Glucagon-like peptide-1 receptor agonist Sodium glucose transporter-2 inhibitor 

Notes

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patients in these case reports.

References

  1. 1.
    Kidney Disease: Improving Global Outcomes (KDIGO) Evaluation and Management of Chronic Kidney Disease Work Group. Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.  https://doi.org/10.1038/kisup.2012.72.CrossRefGoogle Scholar
  2. 2.
    Palmer SC, Mavridis D, Navarese E, Craig JC, Tonelli M, Salanti G, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet. 2015;385(9982):2047–56.  https://doi.org/10.1016/S0140-6736(14)62459-4.CrossRefGoogle Scholar
  3. 3.
    Tuttle KR, Lakshmanan MC, Rayner B, Busch RS, Zimmermann AG, Woodward DB, et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol. 2018;6(8):605–17.  https://doi.org/10.1016/S2213-8587(18)30104-9.CrossRefPubMedGoogle Scholar
  4. 4.
    Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.  https://doi.org/10.1056/NEJMoa1504720.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Imamura S, Hirai K, Hirai A. The glucagon-like peptide-1 receptor agonist, liraglutide, attenuates the progression of overt diabetic nephropathy in type 2 diabetic patients. Tohoku J Exp Med. 2013;231(1):57–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Perkovic V, de Zeeuw D, Mahaffey KW, Fulcher G, Erondu N, Shaw W, et al. Canagliflozin and renal outcomes in type 2 diabetes: results from the CANVAS program randomised clinical trials. Lancet Diabetes Endocrinol. 2018;6(9):691–704.  https://doi.org/10.1016/S2213-8587(18)30141-4.CrossRefPubMedGoogle Scholar
  7. 7.
    Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.  https://doi.org/10.1056/NEJMoa1611925.CrossRefGoogle Scholar
  8. 8.
    Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM. Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Investig. 1986;77(6):1925–30.  https://doi.org/10.1172/JCI112521.CrossRefPubMedGoogle Scholar
  9. 9.
    Hostetter TH, Rosenberg ME, Ibrahim HN, Juknevicius I. Aldosterone in renal disease. Curr Opin Nephrol Hypertens. 2001;10(1):105–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Kodera R, Shikata K, Kataoka HU, Takatsuka T, Miyamoto S, Sasaki M, et al. Glucagon-like peptide-1 receptor agonist ameliorates renal injury through its anti-inflammatory action without lowering blood glucose level in a rat model of type 1 diabetes. Diabetologia. 2011;54(4):965–78.  https://doi.org/10.1007/s00125-010-2028-x.CrossRefPubMedGoogle Scholar
  11. 11.
    Cherney DZ, Perkins BA, Soleymanlou N, Maione M, Lai V, Lee A, et al. Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation. 2014;129(5):587–97.  https://doi.org/10.1161/CIRCULATIONAHA.113.005081.CrossRefPubMedGoogle Scholar
  12. 12.
    Ishibashi Y, Matsui T, Yamagishi S. Tofogliflozin. A highly selective inhibitor of SGLT2 blocks proinflammatory and proapoptotic effects of glucose overload on proximal tubular cells partly by suppressing oxidative stress generation. Horm Metab Res. 2016;48(3):191–5.  https://doi.org/10.1055/s-0035-1555791.CrossRefPubMedGoogle Scholar
  13. 13.
    Barnett AH, Mithal A, Manassie J, Jones R, Rattunde H, Woerle HJ, et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2(5):369–84.  https://doi.org/10.1016/S2213-8587(13)70208-0.CrossRefPubMedGoogle Scholar
  14. 14.
    Boye KS, Botros FT, Haupt A, Woodward B, Lage MJ. Glucagon-like peptide-1 receptor agonist use and renal impairment: a retrospective analysis of an electronic health records database in the US population. Diabetes Ther. 2018;9(2):637–50.  https://doi.org/10.1007/s13300-018-0377-5.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hahn K, Ejaz AA, Kanbay M, Lanaspa MA, Johnson RJ. Acute kidney injury from SGLT2 inhibitors: potential mechanisms. Nat Rev Nephrol. 2016;12(12):711–2.  https://doi.org/10.1038/nrneph.2016.159.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Junki Morino
    • 1
  • Keiji Hirai
    • 1
    Email author
  • Shohei Kaneko
    • 1
  • Saori Minato
    • 1
  • Katsunori Yanai
    • 1
  • Yuko Mutsuyoshi
    • 1
  • Hiroki Ishii
    • 1
  • Momoko Matsuyama
    • 1
  • Taisuke Kitano
    • 1
  • Mitsutoshi Shindo
    • 1
  • Akinori Aomatsu
    • 1
  • Haruhisa Miyazawa
    • 1
  • Kiyonori Ito
    • 1
  • Yuichiro Ueda
    • 1
  • Taro Hoshino
    • 1
  • Susumu Ookawara
    • 1
  • Kazuo Hara
    • 2
  • Yoshiyuki Morishita
    • 1
  1. 1.Division of Nephrology, First Department of Integrated Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
  2. 2.Division of Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan

Personalised recommendations