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Medications and Kidney Complications, Symptoms of Diabetic Ketoacidosis

Cheryl Lathrop

Last updated: November 9, 2016 9:14 pm

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Your kidneys are two organs located on either side of your backbone just above your waist. They remove waste and excess fluid from the blood, maintain the balance of salt and minerals in the blood, and help regulate blood pressure, among other functions. 1 If damaged, they can cause you to have health issues.

Acute Renal Injury

A sudden loss of kidney function can be caused by: lack of blood flow to the kidneys, direct damage to the kidneys, or blockage of urine from the kidneys. Common causes of these losses of function may include: traumatic injury, dehydration, severe systemic infection (sepsis), damage from drugs/toxins or pregnancy complications.  2

Chronic Kidney Disease

When kidney damage and decreased function lasts longer than three months, it is called chronic kidney disease (CKD). CKD can be dangerous, as you may not have any symptoms until after the kidney damage, which may or may not be able to be repaired, has occurred. High blood pressure and diabetes (types 1 and 2) are the most common causes of CKD. 3

Causes of Chronic Kidney Disease

There are also other causes of CKD. These can include:

  • Immune system conditions (e.g., lupus)
  • Long-term viral illnesses (HIV/AIDS, hepatitis B, hepatitis C)
  • Pyelonephritis (urinary tract infections within the kidneys)
  • Inflammation in the kidney’s filters (glomeruli)
  • Polycystic kidney disease (fluid-filled cysts form in the kidneys)
  • Congenital defects (malformations present at birth)
  • Toxins, chemicals
  • Drugs (prescription, over-the-counter, and street) 4 

Type 2 Diabetes Symptoms

People with uncontrolled type 2 diabetes have high levels of sugar (glucose) building up and circulating in the blood. This high blood sugar can cause heart disease, stroke, kidney disease, blindness and nerve damage, among other complications. 5

You may have no type 2 diabetes symptoms, or symptoms may appear gradually. Symptoms may include: increased thirst, increased hunger, dry mouth, frequent urination, unexplained weight loss, fatigue and blurred vision. Additional symptoms may include: slow-healing wounds, itchy skin, yeast infections, recent weight gain, numbness or tingling in the hands and feet, impotence or erectile dysfunction. 6 

SGLT2 Inhibitors Can Cause Diabetic Ketoacidosis

SGLT2 inhibitors (sodium-glucose cotransporter-2) are a class of prescription medicines for type 2 diabetes. The single-ingredient products include: canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

SGLT2 inhibitors lower blood sugar by keeping the kidneys from recirculating sugar to the body, and so it is instead expelled through urine. But this class of drugs may cause kidney complications and other side effects 7

After conducting a safety review, the FDA has added warnings to the labeling for all of the SGLT2 inhibitors regarding too much acid in the blood (diabetic ketoacidosis or DKA), urinary tract infections that have spread to the blood (urosepsis), and urinary tract infections that have spread to the kidneys (pyelonephritis). In May 2015, the FDA issued a Safety Communication about SGLT2 inhibitors and diabetic ketoacidosis. In December 2015, the FDA updated this Safety Communication and added warnings to the labels of SGLT2 inhibitors. 8 9

Health Canada issued a Summary Safety Review in October, 2015 advising Canadians of the potential risks of acute kidney injury with SGLT2 inhibitors, after initiating an earlier safety review in June, 2015 regarding the risk of ketoacidosis. 10

Symptoms of Diabetic Ketoacidosis

Symptoms of diabetic ketoacidosis include: nausea, vomiting, abdominal pain, unusual tiredness and trouble breathing. If any of these symptoms occur while taking an SGLT2 inhibitor, the medication should be discontinued and medical attention sought immediately, the FDA says. 11

Kidney Failure

Kidney damage tends to be permanent. But it can be treated effectively if caught in the early stages. Your health care provider can order simple tests, such as a glomerular filtration rate or a urine protein test if it is suspected. However, if one or both kidneys fail completely and the damage can’t be reversed, it is called kidney failure or end-stage renal disease (ESRD). Treatments for kidney failure include dialysis or transplantation. 12

You should know the warning signs of kidney disease so you can talk to your healthcare provider about any concerns you may have and so that treatment can be initiated, if necessary. Kidney disease warning signs may include:

  • High blood pressure
  • Blood and/or protein in the urine
  • Kidney function tests outside normal ranges
  • More frequent, difficult, or painful urination
  • Puffiness around eyes or swelling of hands and feet 13
  1. http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information 

  2. http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information 

  3. http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information; http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information?page=2 

  4. http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information?page=2 

  5. http://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus 

  6. http://www.webmd.com/diabetes/guide/diabetes-basics?page=3 

  7. http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/sglt2-eng.php; http://www.fda.gov/Drugs/DrugSafety/ucm475463.htm 

  8. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm 

  9. http://www.fda.gov/Drugs/DrugSafety/ucm475463.htm 

  10. http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/sglt2-eng.php; http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2015/53892a-eng.php 

  11. http://www.fda.gov/Drugs/DrugSafety/ucm475463.htm 

  12. https://www.nlm.nih.gov/medlineplus/magazine/issues/winter08/articles/winter08pg9-10.html 

  13. https://www.kidney.org/kidneydisease/howkidneyswrk