Mechanisms of renoprotective action of sodium-glucose cotransporter-2 inhibitors (gliflozins): a clinician’s view

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a group of drugs that block the enzyme responsible for reabsorption glucose and sodium in proximal part nephron. They appeared clinical practice about decade ago treatment type 2 diabetes mellitus, but first studies showed potential these agents preventing cardiovascular renal events. Among main mechanisms renoprotective effect SGLT2i, following distinguished now: 1)reduction hyperfiltration/pressure glomerulus (narrowing afferent dilation efferent arterioles); 2) metabolic shift towards use free fatty acids obtaining energy (increasing efficiency reducing lipotoxic damage to cells); 3) antihypoxic (direct— due decrease oxygen needs indirect— an increase hemoglobin); 4) reduction pressure fluid overload; 5) anti-inflammatory antifibrotic effects; 6)other effects (decrease glycaemia, body weight, uric acid level, etc.). Presumably, SGLT2i administration causes universal cellular reaction (autophagic flux), which leads improved efficiency, reduces stress increases resistance cells overload. The significance various formation overall differs depending on cause kidney damage, concomitant pathology, characteristics patient, degree ischemia, etc. It is different not only each individual but, probably, same patient at stages disease. However, implementation allows development/progression failure prolonging life patients.