Sodium-Glucose Cotransporter-2–inhibitors in Adult Patients With Alport Syndrome

Introduction Alport syndrome (AS) is a genetically heterogenous kidney disease characterised by microhaematuria, proteinuria, and progressive chronic kidney disease (CKD). Although early renin-angiotensin system inhibitors (RASi) are standard of care, evidence on sodium-glucose cotransporter-2 inhibitors (SGLT2i) in AS is limited. Thus, this study evaluated SGLT2i effects in adult AS patients. Methods We conducted a retrospective, observational study including genetically confirmed AS patients with significant proteinuria treated with combined RASi+SGLT2i. Clinical-laboratory data were collected longitudinally and compared with the preceding decade on stable RASi alone. Chronic estimated glomerular filtration rate (eGFR) and proteinuria slopes, changes in time-averaged proteinuria, subgroups responses, and secondary SGLT2i effects were assessed. Results Eighteen adult AS patients (mean age 54.3±15.4 years; baseline eGFR 61.9±26.5 mL/min/1.73m 2 ; median proteinuria 1010.0 [521.8;1662.5] mg/g) initiated RASi+SGLT2i therapy. Over 24.5±13.5 months, the chronic eGFR slope improved significantly (from -3.48 to +0.72 mL/min/1.73m2/year, P