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SGLT2 Inhibitors and Complicated Urinary Tract Infections: A Rare Case of Emphysematous Pyelonephritis and Subsequent

Harveen Kaur1,2, Shaylika Chauhan3, Manajyoti Yadav2

  • 1Department of Internal Medicine University of Chicago Medical Center Chicago Illinois USA.

Clinical Case Reports
|October 20, 2025
PubMed

Insights

Clinicians should be cautious when prescribing dapagliflozin (a sodium-glucose co-transporter-2 inhibitor) due to a potential increased risk of severe urinary tract infections (UTIs). A case study highlights recurrent pyelonephritis in a patient taking this medication.

Area of Science:

  • Nephrology
  • Pharmacology
  • Infectious Diseases

Background:

  • Sodium-glucose co-transporter-2 (SGLT2) inhibitors are commonly prescribed for type 2 diabetes.
  • Urinary tract infections (UTIs) are a known potential side effect of SGLT2 inhibitors.
  • Emphysematous pyelonephritis is a rare but severe complication of UTIs.

Purpose of the Study:

  • To report a case of severe and recurrent pyelonephritis in a patient treated with dapagliflozin.
  • To highlight the potential association between dapagliflozin use and complicated UTIs.

Main Methods:

  • Case report presentation.
  • Review of patient's medical history and medication.
  • Clinical observation of infection recurrence upon drug re-challenge.

Main Results:

  • A patient with no prior UTI history developed emphysematous pyelonephritis while on dapagliflozin.
  • The patient experienced recurrent pyelonephritis after resuming dapagliflozin therapy.
  • This suggests a potential link between dapagliflozin and severe UTIs.

Conclusions:

  • Dapagliflozin may increase the risk of severe and complicated urinary tract infections.
  • Clinicians should exercise caution when prescribing dapagliflozin, especially in patients with risk factors for UTIs.
  • Further investigation into the mechanism and incidence of SGLT2 inhibitor-associated complicated UTIs is warranted.
Keywords:
dapagliflozinemphysematous pyelonephritisrecurrent pyelonephritissodium‐glucose cotransporter‐2 inhibitorsurinary tract infections

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