Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
REVIEW ARTICLE
The Anticipated Renoprotective Effects of Sodium-glucose Cotransporter 2 Inhibitors
Marie ItoTetsuhiro Tanaka
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JOURNALS OPEN ACCESS

2018 Volume 57 Issue 15 Pages 2105-2114

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Abstract

Sodium-glucose cotransporter 2 (SGLT2), which is specifically expressed on the apical side of proximal tubular cells, is involved in the reabsorption of most of the glucose filtered by the glomeruli, and its inhibitors are gaining publicity as potent antihyperglycemic drugs. In some clinical trials, SGLT2 inhibitors exerted cardiovascular and kidney protective effects, which appeared to be partly independent of the original glucose-lowering effect. SGLT2 inhibitors have both direct and indirect renoprotective effects. The direct effects involve the suppression of hyperplasia/hypertrophy, inflammation, and fibrosis in the proximal tubular cells, utilization of ketone bodies, restored tubuloglomerular feedback, decreased oxygen consumption, improvement in anemia, and preconditioning against ischemia/reperfusion. The indirect effects involve a reduction in insulin levels and resistance, uric acid concentration, body weight, and blood pressure. However, safety concerns remain, including consequences of an enhanced glucose load in the lower nephron, leg amputation, bone fractures, and therapeutic efficacy in patients with advanced chronic kidney disease.

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© 2018 by The Japanese Society of Internal Medicine
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