Medications for Diabetic Kidney Disease: Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors

Mechanism of Action of SGLT-2 Inhibitors
In patients with diabetes, sodium reabsorption is usually increased due to excessive glucose load in the renal tubules.SGLT-2 inhibitors reduce sodium reabsorption by blocking this cotransporter.The resulting natriuresis reduces intravascular volume and blood pressure, but also increases sodium delivery to the macula densa.This restores normal tubuloglomerular feedback and reduces intraglomerular pressure by constricting abnormally dilated afferent arterioles (i.e., reducing glomerular hyperfiltration).Reduction of glomerular hyperfiltration is thought to slow the progression of kidney disease.
Common Medications and Administration

Canagliflozin
Dapagliflozin
Empagliflozin

Dosage:

Canagliflozin: 100 mg once daily
Dapagliflozin: 10 mg once daily
Empagliflozin: 10 mg once daily

Dose escalation is not required to achieve renal protection or cardiovascular benefits.Initiation of SGLT-2 inhibitors is generally avoided in patients with eGFR < 20 mL/(min·1.73m²),although patients may still continue treatment safely once eGFR eventually falls below this threshold.
Side Effects
SGLT-2 inhibitors increase the risk of genital fungal infections and may raise the risk of lower limb amputation.Therefore, their use should be avoided in patients at risk of genital fungal infections or lower limb amputation.

Note: The above is an introduction to medications related to diabetic kidney disease, provided for reference only before formal treatment of diabetic kidney disease.Given the complexity of diabetic kidney disease, please receive treatment at a hospital and use medications rationally under the guidance of a doctor.