RT Journal Article
T1 Antihyperglycemic agents as novel natriuretic therapies in diabetic kidney disease.
A1 León Jiménez, David
A1 Cherney, David Z I
A1 Bjornstad, Petter
A1 Castilla-Guerra, Luis
A1 Miramontes González, José Pablo
K1 albuminuria
K1 anhidrasa carbonic
K1 diabetic kidney disease
K1 natriuresis
K1 sodium glucose type 2 inhibitor
AB While sodium-glucose cotransporter-2 (SGLT2) inhibitors have been used for the routine management of type 2 diabetes for several years, it is perhaps their natriuretic effects that are most important clinically. This natriuresis activates tubuloglomerular feedback, resulting in reduced glomerular hypertension and proteinuria, leading to renal protective effects in the EMPA-REG OUTCOME and CANVAS Program trials. In the cardiovascular system, it is likely that plasma volume contraction due to natriuresis in response to SGLT2 inhibition is at least in part responsible for the reduction in the risk of heart failure observed in these trials. We compare this mechanism of action with other antidiabetics. Importantly, other diuretic classes, including thiazide and loop diuretics, have not resulted in such robust clinical benefits in patients with type 2 diabetes, possibly because these older agents do not influence intraglomerular pressure directly. In contrast, SGLT2 inhibitors do have important physiological similarities with carbonic anhydrase inhibitors, which also act proximally, and have been shown to activate tubuloglomerular feedback.
YR 2018
FD 2018-08-01
LK http://hdl.handle.net/10668/12786
UL http://hdl.handle.net/10668/12786
LA en
DS RISalud
RD Apr 15, 2025