Can Jardiance (Empagliflozin) cause foamy urine?

Jardiance (Empagliflozin) and Foamy Urine

Jardiance (empagliflozin) can cause foamy urine due to its mechanism of action promoting glucosuria, though this is generally not a cause for concern unless accompanied by other symptoms of kidney dysfunction.

Mechanism Behind Foamy Urine with SGLT2 Inhibitors

Empagliflozin works by inhibiting sodium-glucose cotransporter 2 (SGLT2) proteins in the proximal convoluted tubule of the kidneys, which:

• Blocks reabsorption of glucose and sodium in the kidney 1
• Promotes urinary glucose excretion (glycosuria) 1
• Increases osmotic diuresis 1

The presence of glucose in the urine can alter its surface tension properties, potentially leading to foamy appearance when voiding.

Clinical Significance of Foamy Urine

Foamy urine is often associated with proteinuria, but this connection requires context:

• In the general population, only about 22.2% of patients complaining of foamy urine actually have overt proteinuria 2
• Increased serum creatinine and phosphate were statistically significant risk factors for proteinuria in patients with foamy urine 2

SGLT2 Inhibitors and Renal Effects

Empagliflozin has been shown to have beneficial renal effects:

• Reduces intraglomerular pressure and albuminuria 3
• Slows GFR loss through mechanisms independent of glycemia 3
• Reduces the risk of incident or worsening nephropathy by 39% 3
• Decreases the risk of doubling of serum creatinine by 44% 3
• Reduces renal oxidative stress by >50% 3

Monitoring Recommendations

If you're experiencing foamy urine while taking Jardiance:

1. Monitor for other symptoms of kidney dysfunction:

   • Changes in urination frequency or volume
   • Swelling in extremities
   • Unexplained fatigue

2. Follow recommended monitoring for all patients on SGLT2 inhibitors:

   • Regular assessment of renal function, especially at treatment initiation 3
   • Monitoring for signs of volume depletion 1
   • Awareness of potential for genital mycotic infections 1

When to Seek Medical Attention

Consult your healthcare provider if foamy urine is accompanied by:

• Decreased urine output
• Edema (swelling)
• Significant changes in renal function tests
• Signs of euglycemic diabetic ketoacidosis (rare but serious side effect) 4

Important Considerations

• Increased urination is an expected effect of Jardiance and indicates the medication is working 1
• Maintain adequate hydration while taking this medication 1
• Foamy urine alone, without other symptoms or laboratory abnormalities, is generally not a cause for concern in patients taking SGLT2 inhibitors

In summary, while foamy urine can occur with Jardiance use due to its mechanism promoting glucose excretion, this finding alone is not typically concerning. However, it's important to maintain regular monitoring of kidney function as recommended for all patients taking SGLT2 inhibitors.