Effects of SGLT2 inhibitors on routine urinary analysis

The advent and increasing clinical application of sodium-glucose co-transporter-2 (SGLT2) inhibitors have underscored their significant therapeutic benefits, particularly in the management of diabetes mellitus and its cardiovascular and renal complications.However, this medication class requires a critical assessment of its effects on urinalysis because of its ability to promote glucose excretion in urine [1,2].The introduction of the SGLT2-inhibitors has initiated a paradigm shift among both clinicians and laboratory medicine experts.In the past, all efforts were oriented toward reducing glucosuria.Consequently, the methodology focused on improving the sensitivity of urinary glucose assays.Therefore, interest has shifted away from the interpretation of the interference of excess glucosuria on other urinary parameters.Nonetheless, the huge and highly advantageous effect of SGLT2-inhibitors-induced glucosuria should reopen the old discussion on its interference in urinary tests such as creatinine, urea, ketonuria, electrolytes, and particle counts.Despite the introduction of enzymatic creatinine assays into routine clinical chemistry laboratories in the late '80s, "Jaffe" (alkaline picrate-based) colorimetric methods remain the most common methods for assaying creatinine in serum, plasma, and urine.Because of the low cost of Jaffe-based creatinine reagents, economic arguments are still preventing the switch to enzymatic methods in many parts of the world.