Osmotic Nephrosis and Acute Kidney Injury Associated With SGLT2 Inhibitor Use: A Case Report

Gautam Phadke, Amit Kaushal, Dean R. Tolan, Kai Hahn, Thomas Jensen, Petter Bjornstad, Carlos Roncal-Jimenez, Ana Andres Hernando, Miguel A. Lanaspa, Mariam Priya Alexander, Aleksandra Kukla, Richard J. Johnson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


We report a case of a patient who developed dialysis-requiring acute kidney injury (AKI) after the use of canagliflozin. A 66-year-old man with type 2 diabetes who was recovering from left knee septic arthritis at a rehabilitation facility was admitted with oliguric AKI 5 days after starting treatment with canagliflozin, an inhibitor of sodium/glucose cotransporter 2 (SGLT2). The patient presented with hematuria, non–nephrotic-range proteinuria, and serum creatinine level of 6.8 (baseline, 1.1-1.3) mg/dL. There was no recent use of radiocontrast agents or exposure to other nephrotoxins. The patient subsequently required hemodialysis. Due to recent antibiotic use (ampicillin-sulbactam), acute interstitial nephritis was considered in the differential diagnosis. Kidney biopsy was performed, which showed the presence of osmotic nephropathy. The patient's kidney function returned to baseline after 2 weeks of hemodialysis. This case provides evidence of an association of osmotic nephropathy with the use of canagliflozin and discusses potential mechanisms. We recommend kidney biopsy for cases of severe AKI associated with SGLT2 inhibitors to better understand the relationship of this complication with the use of this class of medications.

Original languageEnglish (US)
Pages (from-to)144-147
Number of pages4
JournalAmerican Journal of Kidney Diseases
Issue number1
StatePublished - Jul 2020


  • Acute renal failure (ARF)
  • SGLT2 inhibitors
  • acute kidney injury (AKI)
  • canagliflozin
  • case report
  • hemodialysis
  • kidney biopsy
  • osmotic nephropathy
  • sodium/glucose cotransporter 2 (SGLT2)

ASJC Scopus subject areas

  • Nephrology


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