Abstract
Until recently progression of diabetic kidney disease could have been slowed down only by the inhibition of the renin-angiotensin system. Inhibitors of SGLT2 (sodium-glucose transporter 2) in the proximal tubulus of the kidney induce natriuresis and by the activation of the tubuloglomerular feedback increase the tone of the afferent arteriole and decrease the glomerular pressure.
Empagliflozin in the study EMPA-REG Outcome significantly decreased the risk of progression of diabetic kidney disease and further analyses also demonstrated its potent antiproteinuric effect. Taking into consideration the concomitant cardioprotective and renoprotective effect of empagliflozin and high mortality, cardiovascular morbidity and risk of progression into end-stage renal disease of diabetic kidney disease treatment with gliflozins should be considered in all patients with diabetic nephropathy.
Exact place of gliflozins in the treatment of patients with diabetic kidney disease will be established by the further ongoing studies with other gliflozins with primary renal endpoints.