Shankar Prasad Nagaraju
1 
, Shilna Muttickal Swaminathan
1 , Priya Rani
1 , Indu Ramachandra Rao
1 , Ravindra Prabhu Attur
1 , Dharshan Rangaswamy
1 , Srinivas Vinayak Shenoy
1 , Ankur Gupta
2 , Mohan V Bhojaraja
1* 1 Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
2 Department of Nephrology, Palmerston North Hospital, New Zealand
Abstract
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.
Implication for health policy/practice/research/medical education:
The new class of oral hypoglycemic drugs known as sodium-glucose cotransporter-2 inhibitors (SGLT2i) gained attention in modern therapies targeted at nephroprotection in patients with systemic lupus erythematosus (SLE) by increasing autophagy flux and reducing podocyte injury.
Please cite this paper as: Nagaraju SP, Swaminathan SM, Rani P, Rao IR, Attur RP, Rangaswamy D, Shenoy SV, Gupta A, Bhojaraja MV. The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on renoprotection in lupus nephritis: a comprehensive review. J Nephropharmacol. 2025;14(1):e12724. DOI: 10.34172/npj.2025.12724.