Patients with Focal Segmental Glomerulosclerosis (FSGS) constitute an increasing proportion of the total glomerulonephritis (GN) patient cohort in North America while FSGS is a risk factor for end stage renal failure. Current non-immunological FSGS therapies include the use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), to reduce intraglomerular hypertension. Unfortunately, these agents lead to incomplete renal protection. The aim of the current study is to determine whether the addition of novel sodium glucose cotransport-2 inhibitors (SGLT2i) to standard of care leads to reduced intraglomerular pressure and suppression of proteinuria. We hypothesize that combination therapy of SGLT2i drugs and conventional RAASi results in additive renal protective effects in FSGS patients. A further goal is to examine mechanisms of SGLT2 inhibition by measuring renal hemodynamic function and sodium handling. Kidney function will be assessed in FSGS patients before and after an 8 week treatment with SGLT2i dapagliflozin.
FSGS and diabetic nephropathy may have common pathogenic mechanisms, that are mediated by intraglomerular hypertension, leading to hyperfiltration and proteinuria. Given that SGLT2i corrects early hemodynamic abnormalities in patients with diabetes, our aim is to determine if a similar benefit may extend to patients with FSGS. Based on previous experimental and clinical data, we hypothesize that SGLT2i will improve renal hemodynamic abnormalities characteristic of FSGS that promote renal injury and proteinuria.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Oral tablet, 10mg, PO, 8 weeks
Renal Physiology Laboratory, University Health Network
Toronto, Ontario, Canada
The change in Glomerular Filtration Rate (GFR) After an 8 week treatment with dapagliflozin
Glomerular Filtration Rate (GFR, based on plasma inulin clearance) will be measured at baseline and after 8 weeks of treatment.
Time frame: Before and after an 8 week treatment with dapagliflozin
The change in Effective Renal Plasma Flow (ERPF) After an 8 week treatment with dapagliflozin
Effective Renal Plasma Flow (ERPF, based on paraaminohippurate plasma clearance) will be measured at baseline and after 8 weeks of treatment.
Time frame: Before and after an 8 week treatment with dapagliflozin
The change in Blood Pressure After an 8 week treatment with dapagliflozin
Time frame: Before and after 8 weeks of treatment with dapagliflozin
The change in albuminuria after 8 weeks of treatment with dapagliflozin
Time frame: Before and after 8 weeks of treatment with dapagliflozin
The change in urinary vasoactive mediators after 8 weeks of treatment with dapagliflozin
Time frame: Before and after 8 weeks of treatment with dapagliflozin
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