Abstract
Studies have examined the effect of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, on chronic kidney disease (CKD), including immunoglobulin A nephropathy (IgAN). Dapagliflozin decreases albuminuria and slows the decline in estimated glomerular filtration rate (eGFR). However, its renoprotective effects may not be observed in all patients with IgAN in real-world clinical practice. In this study, we aimed to investigate the potential relationship between renal histopathology analyzed using imaging software and the renoprotective effects of dapagliflozin. The mesangial matrix fraction in patients with IgAN was analyzed using ImageJ, an imaging software. The relationships between eGFR decline, changes in urinary protein, and the degree of mesangial matrix fraction before and after dapagliflozin treatment were investigated. A significant negative correlation was evident between the degree of mesangial matrix fraction and eGFR in patients with IgAN. Specifically, when the mesangial matrix fraction exceeded 10% of the total glomerular surface area, eGFR decline was not observed after dapagliflozin administration. Mesangial matrix fraction analysis using imaging software can predict the renoprotective effect of dapagliflozin in IgAN.