Dika Živka, Živko Marijana, Kljajić Marina, Jelaković Bojan
School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia.
Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
J Clin Med. 2024 Oct 9;13(19):6017. doi: 10.3390/jcm13196017.
Urolithiasis (UL) is increasingly prevalent due to rising cardiorenometabolic diseases, posing significant management challenges despite advances in urological techniques. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, primarily used for type 2 diabetes mellitus, chronic kidney disease, and heart failure, have emerged as a potential novel approach for UL treatment. These inhibitors may help reduce the risk of urolithiasis, particularly in patients with diabetes, by improving glycemic control and altering urinary chemistry, which are crucial factors in stone formation. However, the changes in urinary composition induced by SGLT2 inhibitors might also increase the risk of uric acid stone formation. This review evaluates the potential of SGLT2 inhibitors in managing UL, highlighting both the benefits and the risks. While these inhibitors show promise in reducing new and recurrent urinary stones in patients with diabetes, data on their effects in patients without diabetes who form stones are limited. Current human evidence largely comes from post hoc analyses of randomized controlled trials (RCTs) and large-scale database studies, with only one study providing detailed stone composition data. Experimental studies in animal models and cell lines have focused on calcium oxalate (CaOx) stones, showing that SGLT2 inhibitors specifically target CaOx stone formation and related renal inflammation. Although primarily studied for CaOx stones, their potential impact on other calcium-containing stones, such as calcium phosphate, remains promising. Further research is needed to explore their therapeutic potential and optimize treatment strategies.
由于心血管和肾脏代谢疾病的增加，尿石症（UL）越来越普遍，尽管泌尿外科技术有所进步，但仍带来了重大的管理挑战。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂主要用于治疗2型糖尿病、慢性肾病和心力衰竭，已成为一种潜在的新型尿石症治疗方法。这些抑制剂可能有助于降低尿石症风险，特别是在糖尿病患者中，通过改善血糖控制和改变尿液化学成分，而这些是结石形成的关键因素。然而，SGLT2抑制剂引起的尿液成分变化也可能增加尿酸结石形成的风险。本综述评估了SGLT2抑制剂在管理尿石症方面的潜力，强调了其益处和风险。虽然这些抑制剂在减少糖尿病患者新发和复发性尿路结石方面显示出前景，但关于它们对无糖尿病结石患者影响的数据有限。目前的人体证据主要来自随机对照试验（RCT）的事后分析和大规模数据库研究，只有一项研究提供了详细的结石成分数据。动物模型和细胞系的实验研究主要集中在草酸钙（CaOx）结石上，表明SGLT2抑制剂特异性靶向CaOx结石形成及相关的肾脏炎症。尽管主要针对CaOx结石进行研究，但它们对其他含钙结石（如磷酸钙）的潜在影响仍然很有前景。需要进一步研究来探索它们的治疗潜力并优化治疗策略。
