August 30, 2023. Glomerular Hyperfiltration and SGLT-2 Inhibitors in Early Diabetes

Article name: The Proximal Tubule in the Pathophysiology of the Diabetic Kidney

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DOI

This article was published in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology in 2011. It is a review article of the pathophysiology of early diabetic nephropathy at the level of the proximal tubule and glomerular filtration.

Early diabetes mellitus is characterized by an increase in the glomerular filtration rate (GFR). The increased filtered glucose is related to increased glucose reabsorption mostly mediated by the SGLT-2 co-transporter. This leads to hyperplasia and hypertrophy of the proximal tubular cells. this also leads to a decreased sodium and chloride delivery to the macula densa, which in turn mediates an increase in GFR (see this post).

An SGLT-2 inhibitor reduces GFR initially, but ultimately can reduce the rate of progression of renal disease by limiting hyperfiltration damage.

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