Read on Twitter
why do we get natriuresis with SGLT2i?
Could it just be the simple fact that the 'S' in SGLT2i stands for sodium - so blocking sodium reabsorbtion in PT = natriuresis?
Alicia McDonough robs me of that simplistic thinking at the #KidneyWk talk on this (h/t @VelezNephHepato)
Could it just be the simple fact that the 'S' in SGLT2i stands for sodium - so blocking sodium reabsorbtion in PT = natriuresis?
Alicia McDonough robs me of that simplistic thinking at the #KidneyWk talk on this (h/t @VelezNephHepato)
Firstly, SGLT2i can increase even the paracellular Na *secretion*
From this @CO_Neph_Hype review https://pubmed.ncbi.nlm.nih.gov/31815757/
#KidneyWk
From this @CO_Neph_Hype review https://pubmed.ncbi.nlm.nih.gov/31815757/
#KidneyWk
But most of her talk was focused on the NHE3, colacalized with SGLT2i on the proximal tubule
(note the SGLT2i in use have a little bit SGLT1 inhibition - the one with the most Sotagliflozin RCT SCORED will be at AHA)
#KidneyWk
(note the SGLT2i in use have a little bit SGLT1 inhibition - the one with the most Sotagliflozin RCT SCORED will be at AHA)
#KidneyWk
NHE3 reabsorbs Na; the H+ gets recycled
so inhibition of NHE3 = more natriuresis
so SGLT2i inhibition of NHE3 would make a lot of sense. How does it occur? SOme intriguing data on MAP17 mediation here https://journals.physiology.org/doi/abs/10.1152/ajpcell.00275.2019?journalCode=ajpcell
#KidneyWk
so inhibition of NHE3 = more natriuresis
so SGLT2i inhibition of NHE3 would make a lot of sense. How does it occur? SOme intriguing data on MAP17 mediation here https://journals.physiology.org/doi/abs/10.1152/ajpcell.00275.2019?journalCode=ajpcell
#KidneyWk
More here https://pubmed.ncbi.nlm.nih.gov/32893663/ in @AJPRenal
(as an aside NHE3 also causes more bicarbonaturia - which is how NHE3 activity is measured)
#KidneyWK
(as an aside NHE3 also causes more bicarbonaturia - which is how NHE3 activity is measured)
#KidneyWK
This role of NHE3 inhibition in the proximal tubule may also be significant in heart failure as shown in this @biorxivpreprint https://www.biorxiv.org/content/10.1101/2020.07.16.207118v1.full
#KidneyWK
#KidneyWK
She recommends this nice review in @hyperaha https://pubmed.ncbi.nlm.nih.gov/32114848/ from Chris Wilcox which puts most things we know about the topic together nicely
#KidneyWk
#KidneyWk
As an aside Dr McDonough kept calling these 'gliflozins' or 'flozins'
I am liking the 'flozins' instead of the clunky SGLT2i
WHat say #KidneyWK peeps?
I am liking the 'flozins' instead of the clunky SGLT2i
WHat say #KidneyWK peeps?
