Figure 2.

Hemodynamic responses to SGLT2i in patients with early stage type 2 diabetes mellitus (T2DM): in the early stage of T2DM, increased proximal tubular reabsorption will decrease the distal delivery resulting in impaired tubular glomerular feedback (TGF), which present with dilated glomerular afferent arteriolar and increased intraglomerular pressure. SGLT2i treatment will increase solute and fluid delivery to macula densa, which will enhance the secretion of prostaglandins resulting in dilated glomerular efferent arterioles. It also increased the adenosine level trivially, which may slightly increase afferent arteriolar resistance. Both factors reduce the intraglomerular pressure. The net effects will be slightly decreased in GFR but will adequately maintain renal vascular resistance.