SGLT-2 inhibitors in Lupus Nephropathy. It could be considered an intervention of Nephroprotection

Keywords: Systemic lupus erythematosus, Lupus nephropathy, SGLT2 inhibitors, Nephroprotection, Proteinuria, Cardiovascular risk

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatologic disorder. The kidneys are frequently affected organs. The usual treatment of lupus nephritis includes nephroprotective drugs, immunosuppressants, and immunomodulators. SGLT-2 inhibitors are drugs that initially arrived as antidiabetics. Important cardio and nephroprotective effects have been found even in nondiabetic patients. Experimental studies of lu- pus nephritis mentioned the expression of SGLT-2; therefore, this article aims to make an updated review of the evidence on the use of SGLT-2 inhibitors in patients with nephritis. Extensive clinical trials with SGLT-2 inhibitors have generally excluded these patients. The current evidence of the use of iSGLT-2 in lupus nephritis is quite limited and carries from small observational studies and case series, where there are benefits in reducing proteinuria. More trials are required to establish its long-term effects.

Downloads

Download data is not yet available.

References

(1) Arnaud L, Tektonidou MG. Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors. Rheumatol Oxf Engl. 5 de diciembre de 2020;59(Suppl5):v29-38.

(2) Martínez Ávila MC, Almanza Hurtado AJ, Rodríguez Blanco JD, Rodríguez Yánez T, Daza Arnedo R, Aroca Martínez G. Nefro- patía lúpica: una puesta al día. Rev Colomb Reumatol [Internet]. Disponible en: https://www.elsevier.es/es-revista-revista-colombi- ana-reumatologia-374-avance-resumen-nefropatia-lupica-una- puesta-al-S0121812321001274

(3) Anders HJ, Peired AJ, Romagnani P. SGLT2 inhibition requires reconsideration of fundamental paradigms in chronic kidney disease, «diabetic nephropathy», IgA nephropathy and podocyto- pathies with FSGS lesions. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 22 de agosto de 2022;37(9):1609-15.

(4) Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis Off J Natl Kidney Found. agosto de 2020;76(2):265-81.

(5) Vallon V, Verma S. Effects of SGLT2 Inhibitors on Kidney and Cardiovascular Function. Annu Rev Physiol. 10 de febrero de 2021;83:503-28.

(6) Kaur P, Behera BS, Singh S, Munshi A. The pharmacological profile of SGLT2 inhibitors: Focus on mechanistic aspects and pharmaco-genomics. Eur J Pharmacol. 5 de agosto de 2021;904:174169.

(7) DeFronzo RA, Reeves WB, Awad AS. Pathophysiology of diabetic kidney disease: impact of SGLT2 inhibitors. Nat Rev Nephrol. mayo de 2021;17(5):319-34.

(8) 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. 26 de noviembre de 2015;373(22):2117-28.

(9) Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 28 de julio de 2016;375(4):323-34.

(10) Hakroush S, Tampe D, Kluge IA, Baier E, Korsten P, Tampe B. Comparative analysis of SGLT-2 expression in renal vasculitis and lupus nephritis. Ann Rheum Dis. julio de 2022;81(7):1048-50.

(11) Cherney DZI, Dekkers CCJ, Barbour SJ, Cattran D, Abdul Gafor AH, Greasley PJ, et al. Effects of the SGLT2 inhibitor dapagliflo- zin on proteinuria in non-diabetic patients with chronic kidney disease (DIAMOND): a randomised, double-blind, crossover trial. Lancet Diabetes Endocrinol. julio de 2020;8(7):582-93.

(12) Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 8 de octubre de 2020;383(15):1436-46.

(13) EMPA-KIDNEY Collaborative Group. Design, recruitment, and baseline characteristics of the EMPA-KIDNEY trial. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 23 de junio de 2022;37(7):1317-29.

(14) Yamazaki T, Mimura I, Tanaka T, Nangaku M. Treatment of Diabetic Kidney Disease: Current and Future. Diabetes Metab J. enero de 2021;45(1):11-26.

(15) Rico-Fontalvo J, Daza-Arnedo R, Cardona-Blanco MX, Leal-Martínez V, Abuabara-Franco E, Pajaro-Galvis N, et al. SGLT2 Inhibitors and nephroprotection in diabetic kidney disease: From mechanisms of action to the latest evidence in the literature. J Clin Nephrol. 21 de agosto de 2020;4(1):044-55.

(16) 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. 17 de agosto de 2017;377(7):644-57.

(17) Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 24 de enero de 2019;380(4):347-57.

(18) Fontalvo JER. Guía de práctica clínica para la enfermedad renal diabética. Rev Colomb Nefrol [Internet]. 27 de mayo de 2021 [cita- do 28 de junio de 2022];8(2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/561

(19) Säemann M, Kronbichler A. Call for action in ANCA-associated vasculitis and lupus nephritis: promises and challenges of SGLT-2 inhibitors. Ann Rheum Dis. mayo de 2022;81(5):614-7.

(20) Morales E, Galindo M. SGLT2 inhibitors in lupus nephropathy, a new therapeutic strategy for nephroprotection. Ann Rheum Dis. 12 de mayo de 2022;annrheumdis-2022-222512.

(21) Herrington WG, Preiss D, Haynes R, von Eynatten M, Staplin N, Hauske SJ, et al. The potential for improving cardio-renal outcomes by sodium-glucose co-transporter-2 inhibition in people with chro- nic kidney disease: a rationale for the EMPA-KIDNEY study. Clin Kidney J. diciembre de 2018;11(6):749-61.

(22) Fontalvo JER. Guía de práctica clínica para la enfermedad renal diabética. Rev Colomb Nefrol [Internet]. 27 de mayo de 2021 [citado 28 de junio de 2022];8(2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/561

(23) Rico-Fontalvo J, Aroca G, Cabrales J, Daza-Arnedo R, Yánez- Rodríguez T, Martínez-Ávila MC, et al. Molecular Mechanisms of Diabetic Kidney Disease. Int J Mol Sci. 4 de agosto de 2022;23(15):8668.

(24) Rico-Fontalvo J, Aroca G, Cabrales J, Daza-Arnedo R, Yánez- Rodríguez T, Martínez-Ávila MC, et al. Molecular Mechanisms of Diabetic Kidney Disease. IJMS. 2022;23(15):8668.

Published
2022-12-16
How to Cite
1.
Rico-Fontalvo J, Vázquez Jiménez LC, Rodríguez-Yánez T, Daza-Arnedo R, Vergara-Serpa O, Uparella I, Álvarez-Estévez G. SGLT-2 inhibitors in Lupus Nephropathy. It could be considered an intervention of Nephroprotection. Rev. parag. reumatol. [Internet]. 2022Dec.16 [cited 2025Aug.14];8(2):94-100. Available from: http://www.revista.spr.org.py/index.php/spr/article/view/169
Section
REVIEW ARTICLE