Two cases of advanced stage rapidly progressive diabetic nephropathy effectively treated with combination therapy including RAS blocker, GLP-1 receptor agonist and SGLT-2 inhibitor

Abstract

We herein report two cases of advanced stage rapidly progressive diabetic nephropathy that were effectively treated with combination therapy including renin-angiotensin-aldosterone system (RAS) blocker [angiotensin II receptor blocker (ARB)], glucagon-like peptide-1 (GLP-1) receptor agonist and sodium glucose transporter-2 (SGLT-2) inhibitor. A 30-year-old woman with advanced stage diabetic nephropathy [estimated glomerular filtration rate (eGFR): 20.7mL/min/1.73m2; proteinuria: 13.2g/gCr], showing a rapidly progressive pattern (annual eGFR change: - 60.0mL/min/1.73m2/year), had improvement in proteinuria (5.9g/gCr) and eGFR change (+ 4.3mL/min/1.73m2 over 15 weeks) after administration of ARB (irbesartan 25mg/day), GLP-1 receptor agonist (liraglutide 0.3mg/day) and SGLT-2 inhibitor (canagliflozin 50mg/day). A 59-year-old man with advanced stage diabetic nephropathy (eGFR: 32.4mL/min/1.73m2; proteinuria: 8.90g/gCr), showing a rapidly progressive pattern (annual eGFR change: - 21.2mL/min/1.73m2/year), had an improvement in proteinuria (0.02g/gCr) and annual eGFR change (+ 0.1mL/min/1.73m2/year) after combination therapy with ARB (olmesartan 40mg/day), GLP-1 receptor agonist (liraglutide 0.9mg/day) and SGLT-2 inhibitor (tofogliflozin 10mg/day). These results suggest that this triple combination therapy has renoprotective effects on advanced stage rapidly progressive diabetic nephropathy.