Sodium/glucose cotransporter 2 (SGLT2) inhibitors is a new class of anti-diabetic drugs. By blocking SGLT2, the agent decreases glucose uptake from proximal tubules and therefore reduces blood glucose. Acute kidney injury (AKI) can be a side effect from using SGLT2i due to decreased glomerular pressure and volume depletion.
A case report indicates AKI in diabetic patient treated with SGLT2i had biopsy finding of osmotic nephrosis (1). In contrast to hemodynamically-induced AKI in which renal biopsy may show typical acute tubular necrosis (2), biopsy in this patient showed characteristic isometric vacuolization of proximal tubular cells. Osmotic nephrosis is lesion seen in patients receiving hyperosmolar agents such as radiocontrast media. Similar lesion can also be associated with calcineurin inhibitor toxicity in transplant patients.
(1) https://doi.org/10.1053/j.ajkd.2020.01.015
(2) https://doi.org/10.1007/s13730-017-0283-0
