Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of antidiabetic drugs that
inhibit glucose and sodium reabsorption at proximal tubules. These drugs may exhibit renoprotective
properties, since they prevent the deterioration of the glomerular filtration rate and reduce the degree of
albuminuria in patients with diabetes-associated kidney disease. In this review we consider the pathophysiologic
mechanisms that have been recently implicated in the renoprotective properties of SGLT2
inhibitors. The beneficial effects of SGLT2 inhibitors on the conventional risk factors for kidney disease
(such as blood pressure, hyperglycaemia, body weight and serum uric acid levels) may explain, at least in
part, the observed renal-protecting properties of these compounds. However, it has been hypothesized that
the most important mechanisms for this phenomenon include the reduction in the intraglomerular pressure,
the changes in the local and systemic degree of activation of the renin-aldosterone-angiotensin system
and a shift in renal fuel consumption towards more efficient energy substrates such as ketone bodies.
The beneficial effects of SGLT2 inhibitors on various aspects of renal function make them an attractive
choice in patients with (and possibly without) diabetes-associated renal impairment.
Keywords: Sodium-glucose co-transporter 2 inhibitors, kidney, renoprotection, hyperfiltration, ketones, blood pressure.
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