Diabetic kidney disease remains a significant disease burden globally and is associated with increased medical costs once chronic kidney disease (CKD) ensues. Therefore, optimisation of CKD management through glycaemic control and albuminuria reduction are key strategies for retarding renal deterioration. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are a new class of antidiabetic medications that has garnered vast interest since increasing evidence has highlighted— apart from their glycaemic lowering properties—notable cardio- and reno-protective effects. However, concerns of increased acute kidney injury (AKI) have been raised and a few studies reported tubular injury and osmotic nephrosis with SGLT-2 use. We present a case of biopsy-proven osmotic nephrosis and severe acute renal injury following an inadvertent overdose of empagliflozin in a patient with advanced CKD.
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