Renal Function Improvement With Glucagon-Like Peptide-1 Receptor Agonist in a Patient With Type 2 Diabetes

Diabetic kidney disease (DKD) includes hypertensive nephrosclerosis, aging, obesity, and atherosclerosis-related renal diseases, in addition to classical diabetic nephropathy. Sodium-glucose co-transporter 2 inhibitors (SGLT2is) have been approved for diabetic and non-diabetic patients at risk of chronic kidney disease progression. As the main mechanism for SGLT2i-mediated improvement of renal function, the normalization of tubulo-glomerular feedback (TGF) has been proposed. Enhanced TGF and resulting glomerular hypertension are observed in diabetic patients, and SGLT2is normalize TGF, reducing the intraglomerular pressure, which may reduce albuminuria and improve renal function. A type 2 diabetic patient with DKD complicated with hypertensive nephrosclerosis, whose renal function was deteriorated by SGLT2i and improved by glucagon-like peptide-1 receptor agonists (GLP-1RAs), was presented. In patients with hypertensive nephrosclerosis such as this case, the normalization of TGF by SGLT2i may further reduce afferent arteriolar blood flow which may worsen glomerular ischemia, resulting in deterioration of renal function. GLP-1RAs have no effect on TGF and have multiple effects to improve vascular endothelial function, which may be associated with an improvement in renal function in this patient.