The Curbsiders Internal Medicine Podcast #204 NephMadness 2020: SGLT2 Inhibitors
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Apr 6, 2020 
Explore the exciting world of SGLT2 inhibitors with Dr. Harish Seethapathy, Dr. Matt Sparks, and Dr. Joel Topf. They discuss the mechanisms and benefits of these inhibitors for glucose control, cardiovascular health, and chronic kidney disease. The speakers delve into the hemodynamics and regulation of glomerular filtration and explore the various mechanisms of action of SGLT2 inhibitors, emphasizing their impact on inflammation, fibrosis, insulin sensitivity, and more. They also discuss the cancellation of Neffmatin and make predictions for the winners in the NephMadness 2020 SGLT2i region.
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SGLT2i: More Than Glucose Lowering
- SGLT2 inhibitors reduce glucose reabsorption causing sodium delivery changes that impact kidney filtration pressure.
- Their benefits extend beyond glucose lowering to cardiovascular and renal protection shown in large trials.
Tubuloglomerular Feedback Explained
- SGLT2 inhibitors restore tubuloglomerular feedback by increasing sodium delivery to the macula densa.
- This causes afferent arteriole vasoconstriction, reducing intraglomerular pressure and protecting nephrons.
ACEi and SGLT2 Synergy
- ACE inhibitors dilate the efferent arteriole, complementing SGLT2 inhibitors which constrict the afferent arteriole.
- This combination effectively lowers glomerular pressure more than either alone, enhancing kidney protection.