The efficacy of sodium-glucose cotransporter-2 inhibitors (Sglt2i) on renoprotection in lupus nephritis: A comprehensive review

Lupus nephritis (LN) is a major organ condition in systemic lupus erythematosus (SLE) leading to end-stage kidney disease if not managed effectively. Two main therapeutic approaches that are successful in the management of LN include immunosuppression and non-immunosuppressive drugs, renin-angiotensin-aldosterone system inhibitors, and hydroxychloroquine (HCQ), which are supported by numerous clinical trials. Recent clinical trials with sodium-glucose cotransporter-2 inhibitors (SGLT2i) have consistently shown substantial evidence of reno-protection for those with IgA nephropathy and focal segmental glomerulosclerosis. However, emerging evidence shows the protective role of SGLT2i in renal outcomes for the management of LN. This review explores the underlying mechanisms by which SGLT2i contributes to nephroprotection, with promising evidence from both animal and human studies, and guideline recommendations regarding its utilization in LN.