EFFICACY OF SGLT-2 INHIBITOR AS ADD ON THERAPY FOR RESISTANT PROTEINURIA IN GLOMERULONEPHRITIS

Abstract

Background: Chronic glomerulonephritis (CGN) is a leading cause of progressive kidney dysfunction, commonly marked by persistent proteinuria and declining glomerular filtration rate. Proteinuria reduction is essential for slowing disease progression. While renin–angiotensin–aldosterone system (RAAS) blockers and immunosuppressants are standard treatments, many patients with CGN continue to exhibit uncontrolled protein loss. Empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, has demonstrated renoprotective effects in diabetic nephropathy, but its efficacy in non-diabetic proteinuric kidney disease remains underexplored.

Objective: To assess the efficacy and safety of empagliflozin in reducing proteinuria and improving kidney function in CGN patients with treatment-resistant proteinuria.

Methods: This was a non-randomized controlled trial conducted over six months at the Department of Nephrology, AFIU. A total of 200 adult patients (aged 20–60 years) with biopsy-proven CGN, proteinuria >500 mg/g, and eGFR ≥30 mL/min/1.73 m² were enrolled. Participants were assigned to either empagliflozin 25 mg daily (n = 100) or placebo (n = 100), in addition to standard care with RAAS inhibitors and immunosuppressants. Primary outcomes included changes in proteinuria, eGFR, and serum creatinine. Statistical analyses were performed using SPSS version 23, with significance set at p < 0.05.

Results: Empagliflozin significantly reduced proteinuria by −225 ± 40 mg/g versus −10 ± 25 mg/g in the placebo group (p < 0.001). eGFR improved by +5.1 ± 3.4 mL/min/1.73 m² compared to −0.4 ± 1.2 in placebo (p < 0.001), while serum creatinine decreased by −0.12 ± 0.05 mg/dL vs +0.02 ± 0.08 mg/dL (p < 0.001). Greater reductions were observed in patients with baseline proteinuria ≥750 mg/g. Urinary tract infections occurred in 8% of empagliflozin users versus 2% of placebo (p = 0.03), with no serious adverse events noted.

Conclusion: Empagliflozin effectively reduces proteinuria and enhances kidney function in patients with CGN unresponsive to conventional therapies, presenting a promising adjunctive treatment strategy.