Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were initially developed to treat diabetes and have been shown to improve renal and cardiovascular outcomes in patients with- but also without diabetes. The mechanisms underlying these beneficial effects are incompletely understood, as is the response variability between- and within patients. Imaging modalities allow in vivo quantitative assessment of physiological, pathophysiological, and pharmacological processes at kidney tissue level and are therefore increasingly being used in nephrology. They provide unique insights into the renoprotective effects of SGLT2i and the variability in response and may thus contribute to improved treatment of the individual patient. In this mini-review, we highlight current work and opportunities of renal imaging modalities to assess renal oxygenation and hypoxia, fibrosis as well as interaction between SGLT2i and their transporters. Although every modality allows quantitative assessment of particular parameters of interest, we conclude that especially the complementary value of combining imaging modalities in a single clinical trial aids in an integrated understanding of the pharmacology of SGLT2i and their response variability.
Highlights
The sodium-glucose cotransporter-2 (SGLT2), located in the proximal tubules of the kidneys, is responsible for 80–90% of glucose reabsorption
The mechanisms underlying the beneficial effects and response variability of drugs acting in the kidneys of chronic kidney disease (CKD) patients are incompletely understood
Oxygen delivery is primarily influenced by the delivery of blood to the kidneys, which should be separately assessed by measurement of renal blood flow (RBF) or renal perfusion (RP)
Summary
Modalities to Understand the Renoprotective Effects of SodiumGlucose Cotransporter-2 Inhibitors at a Tissue Level. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were initially developed to treat diabetes and have been shown to improve renal and cardiovascular outcomes in patients with- and without diabetes The mechanisms underlying these beneficial effects are incompletely understood, as is the response variability between- and within patients. Imaging modalities allow in vivo quantitative assessment of physiological, pathophysiological, and pharmacological processes at kidney tissue level and are increasingly being used in nephrology. They provide unique insights into the renoprotective effects of SGLT2i and the variability in response and may contribute to improved treatment of the individual patient.
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