The Hidden Risk of a First-Line Therapy: Renal Abscess With SGLT2 Inhibitor Use
https://doi.org/10.15605/jafes.041.S1
- Author:
Wei Ton Wong
1
;
Khairi Syazwan Rashid
1
;
Afiq Hazim Ab Rahim
1
Author Information
1. Internal Medicine Unit, Hospital Besut
- Publication Type:Journal Article
- MeSH:
Abscess;
Sodium-Glucose Transporter 2 Inhibitors
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):52-53
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Sodium-glucose cotransporter-2 (SGLT2) inhibitors are
cornerstone therapies for heart failure and diabetes,
offering proven cardiorenal benefits. However, expanded
use necessitates vigilance regarding adverse effects,
particularly genitourinary infections. While mild cystitis is
common, serious upper urinary tract infections remain rare
and potentially life-threatening. We describe a case of renal
abscess presenting as recurrent urinary tract infections
(UTI) following SGLT2 inhibitor initiation, emphasizing
the need for clinical vigilance.
Case:A 69-year-old male with a significant cardiovascular
history, including heart failure with reduced ejection
fraction (HFrEF), hypertrophic cardiomyopathy with an
implantable cardioverter-defibrillator for non-sustained
ventricular tachycardia, diabetes mellitus, hypertension,
and hyperlipidemia, presented with a 1-week history of
right flank pain, dysuria, urinary frequency, and fever.
Initial labs confirmed infection: leukocytosis (22.6 × 10³/ µL),
markedly elevated CRP (200 mg/L), and bacteriuria. He was
diagnosed with a UTI and started on IV Cefuroxime. This
marked his third UTI admission in 5 months, following
discharge just 3 weeks prior for septic shock secondary
to UTI, establishing a relapsing pattern. Subsequent urine
and blood cultures were unremarkable. Medication review
revealed Dapagliflozin had been initiated for HFrEF
8 months ago. Following clinical improvement from each prior UTI episode, Dapagliflozin was consistently
restarted. Despite an initial antibiotic response, symptoms
recurred after discharge each time. The recurrent nature
of his infections prompted a renal ultrasound revealing a
large (5.3 × 7.5 × 7.4 cm), non-drainable, heterogeneously
hypoechoic collection at the left kidney’s mid-lower pole,
diagnostic of an early renal abscess.
Conclusion:This report highlights renal abscess as a rare and severe
complication of SGLT2 inhibitor therapy. It serves as a
critical reminder that recurrent or relapsing UTIs in patients
on these agents should prompt immediate investigation
with renal imaging to rule out deep-seated pathology
rather than simple cystitis. While these drugs offer proven
cardiorenal benefits, their role in promoting urological
infections necessitates a cautious approach.
- Full text:2026073015570134612EP_A061.pdf
