Final answer:
SGLT2 inhibitors should be avoided in patients with diabetic nephropathy due to the risk of further kidney damage.
Step-by-step explanation:
SGLT2 inhibitors, specifically canagliflozin, should be avoided in patients with diabetic nephropathy, which is a progressive kidney disease. This disease is caused by damage to the capillaries in the glomeruli of the kidneys due to poor blood sugar control in individuals with diabetes. The complications from this condition can be exacerbated by medications like SGLT2 inhibitors, as they can further damage podocytes and constrict the renal arterioles that can diminish glomerular filtration rate (GFR), particularly in patients with chronically elevated endothelin levels that result in sodium retention and increased stress on already damaged kidneys.