Therapeutic potential of tofogliflozin on nephrotic syndrome secondary to diabetic nephropathy.

Diabetic nephropathy (DN) is a critical complication in patients with type 2 diabetes and regarded as a progressive disorder with a poor prognosis. The degree of albuminuria is associated closely with worse renal and cardiovascular outcomes. It is therefore important to achieve remission of proteinuria to avoid progression of DN and improve outcomes. Although a recent clinical trial demonstrated that a sodium glucose cotransporter 2 (SGLT2) inhibitor could improve cardiovascular and renal outcomes in cardiovascular high risk patients with type 2 diabetes, little is known whether SGLT2 inhibitors have favorably renal effects in patients with nephrotic syndrome associated with DN. Herein, we report a 54-year-old patient with refractory nephrotic syndrome accompanied by diabetic nephropathy. Tofogliflozin, a SGLT2 inhibitor, successfully increased urine volume, and reduced body weight, HbA1c, and urinary protein excretion (10.8 to 2.6 g/day) during 24 weeks. His severe edema also was diminished after administration of tofogliflozin. This case indicates that an SGLT2 inhibitor may be a useful choice in the treatment of patients with diabetic nephropathy and the nephrotic syndrome. <Learning objective: Little is known whether SGLT2 inhibitor can attenuate nephrotic-range of proteinuria in patients with diabetic nephropathy. The present case is the first to demonstrate that tofogliflozin markedly reduced urinary protein excretion, body weight, and relevant markers in patient with nephrotic syndrome secondary to diabetic nephropathy. Thus, it is suggested that SGLT2 inhibitor has a therapeutic potential to attenuate nephrotic syndrome-related symptoms and markers as well as glycemic control.>.