Marzo Aprile 2024 - Nefrologo in corsia

Anti-Proteinuric Effect of GLP1-RA as Add-On to SGLT2-i and ACE-i in a Diabetic Patient with IgA Nephropathy

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Maria Elena Malighetti

Maria Elena Malighetti1, Matteo Faletto2

1 Ambulatorio di Diabetologia, Casa di Cura Ambrosiana, Cesano Boscone, MI, Italia
2 Scuola di Specializzazione in Medicina Interna, IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italia

Corresponding author:
Maria Elena Malighetti
Ambulatorio di Diabetologia, Casa di Cura Ambrosiana,
piazza Monsignor Moneta 1
20090 Cesano Boscone
Tel 02458761
E-mail: mariaelena.malighetti@gmail.com

 

Abstract

Immunoglobulin A (IgA) nephropathy is a common glomerulonephritis, but its treatment remains matter of debate. Recommendation for corticosteroids has been supported, but renin-angiotensin inhibitors, RAAS, and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are increasingly used because of a better benefit/safety balance in comparison with systemic steroids and immunosuppressive treatments. In this case report, a patient with type 2 diabetes (T2DM) and biopsy-proven nephrotic IgA-related nephropathy documented a rapid meaningful reduction of proteinuria and the effect was persistent for 2 years, after receiving the treatment with a GLP1-RA on top of the previous treatment with ACE-inhibitors and SGLT2-i. Considering the beneficial effects of GLP1-RA in diabetes related chronic kidney disease, the present case report supports the notion that these drugs could also represent a beneficial treatment option in IgA nephropathy.

Keywords: IgA nephropathy, Dulaglutide, Empagliflozin, DAPA-CKD, Empa-Kidney

Introduction

IgA nephropathy is the most frequent glomerular disease worldwide. Its clinical course is variable, but in most cases there is a decline in renal function and, despite advances in our understanding of its pathogenesis, treatment strategies haven’t changed much over the last 2 or 3 decades. Patients at greatest risk of progressive renal impairment are those with hypertension, proteinuria >1 g/24 h and reduced glomerular filtration rate at diagnosis [1].

There are no disease-specific therapies for IgA nephropathy and the established treatment approach for most patients is to apply supportive measures that include the use of renin-angiotensin-aldosterone system blockade (RAAS) [1, 2] and more recently SGLT2i (as evidenced by the DAPA-CKD study [3] and by the subanalysis of EMPAKIDNEY study, in which 25% of patients were affected by glomerular diseases) [4].

At present, there is insufficient evidence for the additional use of immunosuppressive agents, antiplatelet agents or anticoagulants. The role of immunosuppressive therapy remains controversial and is usually reserved for patients who don’t respond to supportive measures [2]. 

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