Figures & data
Figure 1. Summary of potential renal benefits of SGLT2 inhibition in patients with T2DM [Citation29] eGFR, estimated glomerular filtration rate, HbA1c, glycated hemoglobin.
![Figure 1. Summary of potential renal benefits of SGLT2 inhibition in patients with T2DM [Citation29] eGFR, estimated glomerular filtration rate, HbA1c, glycated hemoglobin.](/cms/asset/92decaf8-fa70-4954-b95c-de5d4f691159/ipgm_a_1601404_f0001_b.gif)
Figure 2. Summary of potential mechanisms by which SGLT2 inhibitors confer renal/CV protection.
SGLT2 inhibition may provide its cardioprotective and renal protective effects via several mechanisms: (1) SGLT2 inhibition attenuates primary proximal tubular hyperreabsorption in the kidney in diabetes, increasing/restoring the tubuloglomerular feedback signal at the macula densa ([Na+/Cl−/K+]MD) and hydrostatic pressure in Bowman’s space. This reduces glomerular hyperfiltration, beneficially affecting albumin filtration and tubular transport work and, thus, renal oxygen consumption; (2) by lowering blood glucose levels, SGLT2 inhibitors can reduce kidney growth, albuminuria and inflammation; (3) SGLT2 inhibitors have a modest osmotic diuretic, natriuretic and uricosuric effect, which can reduce extracellular volume, blood pressure, serum uric acid levels and body weight. These changes may have beneficial effects on both the renal and cardiovascular systems; (4) SGLT2 may be functionally linked to NHE3, such that SGLT2 inhibition may also inhibit NHE3 in the proximal tubule, with implications on the natriuretic, GFR and blood pressure effect; (5) SGLT2 inhibition reduces insulin levels and the need for therapeutic and/or endogenous insulin, and increases glucagon levels. As a consequence, lipolysis and hepatic gluconeogenesis are elevated. These metabolic adaptations reduce fat tissue/body weight and hypoglycemia risk, and result in mild ketosis, potentially having beneficial effects on both the renal and cardiovascular systems; (6) SGLT2 inhibition may also enhance renal HIF content, which may have renal protective effects. White text boxes indicate affected variables, gray text boxes indicate processes that link SGLT2 inhibition to the reduction in GFR. Green arrows demonstrate consequences, red arrows indicate changes in associated variables (increase/decrease). ECV = extracellular volume; GFR = glomerular filtration rate; HIF = hypoxia-inducible factor; MD = macula densa; NHE3 = sodium-hydrogen exchanger 3; PBow = hydrostatic pressure in Bowman space; SGLT2 = sodium-glucose co-transporter 2.Reproduced with permission [Citation29].
![Figure 2. Summary of potential mechanisms by which SGLT2 inhibitors confer renal/CV protection.SGLT2 inhibition may provide its cardioprotective and renal protective effects via several mechanisms: (1) SGLT2 inhibition attenuates primary proximal tubular hyperreabsorption in the kidney in diabetes, increasing/restoring the tubuloglomerular feedback signal at the macula densa ([Na+/Cl−/K+]MD) and hydrostatic pressure in Bowman’s space. This reduces glomerular hyperfiltration, beneficially affecting albumin filtration and tubular transport work and, thus, renal oxygen consumption; (2) by lowering blood glucose levels, SGLT2 inhibitors can reduce kidney growth, albuminuria and inflammation; (3) SGLT2 inhibitors have a modest osmotic diuretic, natriuretic and uricosuric effect, which can reduce extracellular volume, blood pressure, serum uric acid levels and body weight. These changes may have beneficial effects on both the renal and cardiovascular systems; (4) SGLT2 may be functionally linked to NHE3, such that SGLT2 inhibition may also inhibit NHE3 in the proximal tubule, with implications on the natriuretic, GFR and blood pressure effect; (5) SGLT2 inhibition reduces insulin levels and the need for therapeutic and/or endogenous insulin, and increases glucagon levels. As a consequence, lipolysis and hepatic gluconeogenesis are elevated. These metabolic adaptations reduce fat tissue/body weight and hypoglycemia risk, and result in mild ketosis, potentially having beneficial effects on both the renal and cardiovascular systems; (6) SGLT2 inhibition may also enhance renal HIF content, which may have renal protective effects. White text boxes indicate affected variables, gray text boxes indicate processes that link SGLT2 inhibition to the reduction in GFR. Green arrows demonstrate consequences, red arrows indicate changes in associated variables (increase/decrease). ECV = extracellular volume; GFR = glomerular filtration rate; HIF = hypoxia-inducible factor; MD = macula densa; NHE3 = sodium-hydrogen exchanger 3; PBow = hydrostatic pressure in Bowman space; SGLT2 = sodium-glucose co-transporter 2.Reproduced with permission [Citation29].](/cms/asset/fb53f0dc-b270-4cfd-84e5-389e0d4a5625/ipgm_a_1601404_f0002_c.jpg)
Table 1. Ongoing trials of SGLT2 inhibitors with renal outcomes.
