Case Report: Sodium glucose cotransporter 2 inhibitor use in a pediatric patient with cancer receiving cisplatin

Cisplatin is a foundation chemotherapeutic for pediatric germ cell tumors; however, its dose-dependent nephrotoxicity can limit use. Hypomagnesemia is a challenging side effect, and patients often remain hypomagnesemic despite IV and oral magnesium (Mg) supplementation. Sodium Glucose Cotransporter 2 inhibitors (SGLT2is) have been shown to mitigate cisplatin-induced nephrotoxicity (CIN) and reduce urinary Mg wasting in adults, but their use remains off-label and limited in pediatrics. We report a case of an adolescent male with metastatic germ cell tumor treated extensively with cisplatin, whose course was complicated by hypertension, hypomagnesemia, and a declining glomerular filtration rate (GFR). An SGLT2i was started three months into treatment. His GFR stabilized and his proteinuria resolved despite continued treatment with cisplatin. Additionally, he discontinued IV Mg supplementation while maintaining adequate levels on oral Mg, and his blood pressure improved with discontinuation of antihypertensives. This case highlights a potential role of SGLT2is in pediatric oncology.