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