SHM Converge Scientific Abstract ePoster Gallery-Navigating the Paradox: Acute Kidney Injury Following Empagliflozin Initiation in a Diabetic Patient

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This case report describes a 60-year-old woman with diabetes and hypertension who developed severe acute kidney injury (AKI) two months after starting empagliflozin while also taking valsartan and amlodipine. She presented with dizziness, falls, oliguria, hypotension, and tachycardia. Laboratory testing showed marked renal failure (creatinine 7 mg/dL from a baseline of 1.3 mg/dL, BUN 99 mg/dL). Imaging ruled out stroke and abdominal obstruction, and additional workup excluded glomerulonephritis, vasculitis, and thrombotic microangiopathy. Urinalysis suggested acute tubular necrosis (ATN). <br /><br />The patient required hemodialysis on hospital day 2, after which urine output and mental status improved. Her renal function then recovered toward baseline, and she was discharged on day 5. The authors attribute the AKI to a hemodynamic insult caused by empagliflozin’s osmotic diuresis and natriuresis, combined with concurrent antihypertensive therapy and likely volume depletion. SGLT2 inhibitors increase sodium delivery to the macula densa, promoting afferent arteriolar vasoconstriction, while ARBs such as valsartan cause efferent arteriolar vasodilation; together, these effects can reduce glomerular filtration pressure. A concurrent urinary tract infection may have further worsened renal hypoperfusion.<br /><br />The report emphasizes that although SGLT2 inhibitors generally provide kidney protection and reduce AKI risk in most patients, they can rarely contribute to severe AKI in the setting of hypotension, infection, and other hemodynamic stressors. The case highlights the importance of careful medication review, avoidance of excessive hemodynamic compromise, and close monitoring of kidney function and volume status after SGLT2 inhibitor initiation.

Asset Subtitle

Roger Su

Meta Tag

Author List Roger Su

Category Clinical Vignettes

Concept SGLT-2 Inhibitors

Concept Acute Kidney Injury

Concept Renal Protection

Concept Empagliflozin

Concept Volume Depletion

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Roger Su

Track Adult

Keywords

empagliflozin

acute kidney injury

hemodialysis

acute tubular necrosis

diabetes

hypertension

valsartan

SGLT2 inhibitor

volume depletion

renal failure

SGLT-2 Inhibitors

Acute Kidney Injury

Renal Protection

Empagliflozin

Volume Depletion