Sodium–glucose co-transporter inhibitors (SGLT2i) have recently gained a lot of emphasis in their role in preventing progression of chronic kidney disease and helping with cardiac mortality. Various studies have proven the benefit of these medications in the management of patients with kidney and heart disease. SGLT2i exert their effect in the proximal convoluted tubule with various downstream effects noted in the kidney also. With spreading use of these medications, it is imperative to understand the effects they have on various electrolytes and the pathways involved in bringing about these changes in the kidney. Here, the authors review the current knowledge of SGLT2i with their effects on the kidney, electrolytes, and water balance.
Diabetic kidney disease (DKD) has been an immense burden on the healthcare system, and is the leading cause of end stage kidney disease worldwide. DKD involves various intersecting pathways that lead to progressive kidney damage. Due to its versatile pathogenesis, DKD has been a formidable adversary. For many decades, there has not been much development in the arsenal in the fight against DKD, but recently, multiple new prospects have emerged due to the breakthrough in understanding of DKD pathology. Tireless research of the changes occurring in the kidney as a result of diabetes, and the factors driving these changes, has led to the invention of medications that hopefully will be highly impactful in preventing end stage kidney disease in patients with diabetes. In this review, the authors summarise the timeline of the pathological changes that occur in DKD, the mechanism driving these pathological changes, and the recent discoveries in the pathways leading to DKD. These span over changes in metabolic pathways, inflammatory cascades, epigenetic alterations, and the description of their effects at cellular to structural levels in the kidney as a byproduct of uncontrolled hyperglycaemia. The authors also correlate these mechanisms with a few of the medications that are being utilised to slow down DKD, and some in the pipeline, with some references to the trials that support their use.
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