Beneficial effect of sodium-glucose cotransporter 2 inhibitors on kidney function can be just a mirage

Figure 4 Glucosuria induces osmotic diuresis and subsequent glomerular hyperfiltration. A: In healthy humans with blood glucose concentration below the kidney threshold for glucose reabsorption (approximately 180-200 mg/dL or 10-11 mmol/L), glucose is reabsorbed in the proximal tubule and no glucose is detectable in urine; B: Glucosuria occurs when glucose reabsorption in the proximal tubule is inhibited or when the plasma glucose concentration exceeds the kidney threshold for glucose reabsorption. The presence of glucose in urine requires concomitant elimination of water (osmotic diuresis). Glomerular hyperfiltration may be an adaptive response that arises in order to supply the obligatory loss of water in urine in the setting of glucosuria and osmotic diuresis.