{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:41:33Z","timestamp":1768444893403,"version":"3.49.0"},"reference-count":9,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,10]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>A woman with biopsy-confirmed IgA nephropathy (IgAN) presented with persistent non-nephrotic range proteinuria and stage 3b chronic kidney disease (CKD). Her treatment regimen included the initiation of a sodium-glucose cotransporter 2 inhibitor (SGLT2i), dapagliflozin, starting at 5\u2009mg daily and later titrated to 10\u2009mg daily after several months. Following the dose increase, she developed significant acute-on-chronic kidney injury. Despite discontinuing the SGLT2i, her renal function did not recover. A subsequent kidney biopsy revealed findings consistent with osmotic tubulopathy with worsening IgAN. This case highlights a rare but important adverse effect of SGLT2i, particularly in patients with pre-existing CKD. While initial expert guidance advised against routine renal function monitoring to avoid premature discontinuation due to the expected transient rise in creatinine, evolving clinical experience suggests that individualised monitoring may be necessary in high-risk patients. Future guidelines will need to clarify how to balance these considerations to optimise patient outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2024-263859","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:27:47Z","timestamp":1742956067000},"page":"e263859","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Osmotic nephropathy triggered by sodium-glucose cotransporter 2 inhibitors in a patient with IgA nephropathy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3623-0484","authenticated-orcid":false,"given":"Christopher Thiam Seong","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kar Wah","family":"Fuah","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Sultan Idris Shah Serdang, Kajang, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia Ling","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Sultan Idris Shah Serdang, Kajang, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"2025082713270300000_18.3.e263859.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.03.033"},{"key":"2025082713270300000_18.3.e263859.2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S2213-8587(23)00322-4","article-title":"Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial","volume":"12","author":"Judge","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025082713270300000_18.3.e263859.3","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.2215\/CJN.00150118","article-title":"Pharmacology behind Common Drug Nephrotoxicities","volume":"13","author":"Perazella","year":"2018","journal-title":"CJASN"},{"key":"2025082713270300000_18.3.e263859.4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.10.044"},{"key":"2025082713270300000_18.3.e263859.5","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1053\/j.ajkd.2020.01.015","article-title":"Osmotic Nephrosis and Acute Kidney Injury Associated With SGLT2 Inhibitor Use: A Case Report","volume":"76","author":"Phadke","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2025082713270300000_18.3.e263859.6","unstructured":"Zahorowska B , Roger SD . RENAL tubular epithelial cell isometric vacuolation associated with sodium-glucose co-transporter 2 inhibitor use: a case report. In: Nephrology. 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