SGLT2 inhibitors and acute kidney injury

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are glucose-lowering agents that inhibit glucose reabsorption by the proximal tubules of the kidney. Since the introduction of the first SGLT2i in 2012, dapagliflozin, canagliflozin and empagliflozin have been developed and have been rapidly integrated into clinical medicine, initially to manage type 2 diabetes. Over a short period of time, however, it has become apparent that SGLT2i not only reduce blood glucose but also provides long-term protective effects to the kidneys and heart. In this review, we present physiological data on what is known about SGLT2i effects on the kidney and the ever-expanding clinical data relating to the effects of SGLT2i on the occurrence of acute kidney injury (AKI), and integrate what is known about molecular mechanisms with clinical experience. We conclude that SGLT2i may reduce the risks for AKI in humans. We speculate on mechanisms by which SGLT2 inhibitors may protect against AKI.