classification of DN. Renal function was assessed using estimated glomerular filtration rate (eGFR, CKD-EPI, mL/min/1. 73m 2), urine albumin-to-creatinine ratio (UACR, mg/g), and 24-hour proteinuria (g/24 h). Patients were categorized based on biopsy results as DN or NDRD. Follow-up extended from SGLT2i initiation up to 60 months. Kidney disease progression was defined as 40% decline in eGFR, doubling of serum creatinine, or 30% reduction in UACR or 24-hour proteinuria. ESRD and mortality were also evaluated. Results: Of 248 T2DM patients screened, 181 were excluded due to absence of biopsy or normal/marginal biopsy. Sixty-seven patients were included; 31 (46%) had DN and 36 (54%) had NDRD. Among DN patients, 14 (45%) were classified as nodular sclerosis class III. Compared with NDRD, DN patients exhibited significantly more mesangial expansion, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis. T2DM patients with DN receiving SGLT2i showed a higher prevalence of diabetic retinopathy, better baseline eGFR, and lower UACR than untreated patients (66 mL/min and 1490 mg/g, p40% eGFR decline, doubling of serum creatinine, and fewer achieving 30% reduction in UACR, though differences were not statistically significant. Diabetic retinopathy and insulin therapy were associated with failure to achieve a 30% reduction in UACR. Histological findings associated with renal outcomes included glomerular basement membrane morphology and interstitial inflammation. Normal or thickened membranes were linked to lower risk of creatinine doubling (OR95%CI = 0. 03 0. 00;0. 39and OR95%CI = 0. 05 0. 00;0. 56, respectively), while interstitial inflammation >5% was associated with greater eGFR decline (OR95%CI = 7. 0 1. 04;141). Fewer SGLT2i-treated patients progressed to ESRD or death, although these differences were not statistically significant. Conclusion: In this cohort of T2DM patients with biopsy-proven kidney disease, SGLT2i therapy was significantly associated with longterm preservation of renal function, as evidenced by a slower eGFR decline. These findings are consistent with the well-established nephroprotective effect of SGLT2 inhibitors in diabetic kidney disease and further demonstrate that this beneficial effect persists even in cases with mixed diabetic nephropathy lesions. Although favorable trends were observed in hard renal outcomes and mortality, larger studies are required to confirm these benefits. I have no potential conflict of interest to disclose. I used generative AI and AI-assisted technologies in the writing process.
Kim et al. (Wed,) studied this question.
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