Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, U.S.A.
Nephrology Research, VA San Diego Healthcare System, San Diego, CA, U.S.A.
Clin Sci (Lond). 2018 Jun 28;132(12):1329-1339. doi: 10.1042/CS20171298. Print 2018 Jun 29.
Type 2 diabetes mellitus (T2DM) is a growing public health concern worldwide. Numerous drug classes are available for treatment, however, their efficacy with regard to diabetes-induced renal and cardiovascular (CV) complications remains limited. Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) are a new class of blood glucose lowering medications that block renal glucose reabsorption and have protective effects on the kidney and the heart. This review focusses on the effects of SGLT2 inhibitors on the kidney and renal outcome: it briefly outlines renal glucose handling in diabetes and its role in glomerular hyperfiltration and renal hypoxia; describes how SGLT2 inhibitors induce an early, reversible reduction in glomerular filtration rate (GFR) and preserve GFR in the long-term in patients with T2DM; discusses whether the enhanced active transport in the renal outer medulla (OM) in response to SGLT2 inhibition is friend or foe; proposes how the blood pressure lowering and heart failure protective effect of SGLT2 inhibitors can be preserved in chronic kidney disease (CKD) despite attenuated antihyperglycemic effects; and examines whether SGLT2 inhibition enhances the incidence or severity of acute kidney injury (AKI).
2 型糖尿病（T2DM）是全球日益严重的公共卫生问题。有许多类药物可用于治疗，但它们在糖尿病引起的肾脏和心血管（CV）并发症方面的疗效仍然有限。钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂是一类新型的降低血糖药物，可阻止肾脏对葡萄糖的重吸收，并对肾脏和心脏具有保护作用。本综述重点介绍 SGLT2 抑制剂对肾脏和肾脏结局的影响：它简要概述了糖尿病中的肾脏葡萄糖处理及其在肾小球高滤过和肾脏缺氧中的作用；描述了 SGLT2 抑制剂如何在 T2DM 患者中早期、可逆地降低肾小球滤过率（GFR）并长期保护 GFR；讨论了 SGLT2 抑制剂抑制后对肾脏外髓质（OM）中主动转运的增强是好是坏；提出了尽管抗高血糖作用减弱，SGLT2 抑制剂的降压和心力衰竭保护作用如何在慢性肾脏病（CKD）中得以保留；并检查了 SGLT2 抑制是否会增加急性肾损伤（AKI）的发生率或严重程度。
