CEN Case Reports

, Volume 7, Issue 1, pp 17–20 | Cite as

Dapagliflozin as a cause of acute tubular necrosis with heavy consequences: a case report

  • Christos Pleros
  • Elisavet Stamataki
  • Antonia Papadaki
  • Nikolaos Damianakis
  • Rafaela Poulidaki
  • Charikleia Gakiopoulou
  • Ioannis Tzanakis
Case Report


A 50-year-old man with type II diabetes, hypertension and dyslipidemia, presented with non-oliguric acute kidney injury (AKI) and anemia. Renal biopsy showed acute tubular necrosis (ATN) with extensive cytoplasmic vacuolization and areas of tubulitis. These findings were ultimately attributed to dapagliflozin, which he started 3 months earlier due to poor glycemic control. ATN with similar microscopic findings has been described with larger doses of dapagliflozin in non-clinical trials. Our patient was started on dialysis and remained dialysis-dependent for 4 weeks while his renal function improved gradually thereafter. Sixteen months after initial presentation he is being followed as an outpatient with chronic kidney disease (CKD) stage 3a. Dapagliflozin belongs to a novel class of antidiabetic drugs for which clinical trials show great beneficial effects on cardiovascular outcomes and glycemic control and as with many new drugs, their safety profile is being constantly revised. We report the first biopsy-proven ATN caused by dapagliflozin. Great caution together with continuous monitoring of renal function is advised when implementing SGLT-2 inhibitors in clinical practice.


Acute tubular necrosis (ATN) Dapagliflozin SGLT-2 inhibitors Diabetes 


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Research involving human participants and/or animals

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

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    CANVAS—CANagliflozin cardio Vascular Assessment Study (CANVAS).
  2. 2.
    Multicenter Trial to Evaluate the Effect of Dapagliflozin on the Incidence of Cardiovascular Events (DECLARE-TIMI58).
  3. 3.
    Cardiovascular Outcomes Following Ertugliflozin Treatment in Type 2 Diabetes Mellitus Participants With Vascular Disease, The VERTIS CV Study (MK-8835-004).
  4. 4.
    Zinman B, Wanner C, Lachin JM, et al. for the EMPA-REG OUTCOME investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Faillie JL. Pharmacological aspects of the safety of gliflozins. Pharmacol Res. 2016. Scholar
  6. 6.
    Wu JH, Foote C, Blomster J, et al. Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2016;4(5):411–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Vasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2013;159(4):262 – 74.CrossRefPubMedGoogle Scholar
  8. 8.
    Wanner C, Inzucchi SE, Lachin JM, et al. EMPA-REG OUTCOME investigators. Empagliflozin and progression of kidney disease in Type 2 Diabetes. N Engl J Med. 2016;375(4):323 – 34.CrossRefPubMedGoogle Scholar
  9. 9.
    DeFronzo RA, Norton L, Abdul-Ghani M. Renal, metabolic and cardiovascular considerations of SGLT2 inhibition. Nat Rev Nephrol. 2017;13(1):11–26.CrossRefPubMedGoogle Scholar
  10. 10.
    FDA Drug Safety Communication: FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR) [06-14-2016]
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Agati D’, Jennette VD, Silva JC. FG. Non-neoplastic kidney diseases. Silver Spring: ARP Press; 2005. pp. 517–31.Google Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  1. 1.Department of NephrologyGeneral Hospital of ChaniaChaniaGreece
  2. 2.Division of Pathology, Athens Medical SchoolNational and Kapodistrian University of AthensAthensGreece

Personalised recommendations