Figure 3: Effects of diabetes and sodium–glucose co-transporter-2 inhibition on nephron haemodynamics.

A: Increased resorption of glucose by sodium–glucose co-transporter-2 (SGLT2) in the proximal convoluted tubule decreases delivery of solutes to the macula densa. The resulting decrease in adenosine triphosphate release from the basolateral membrane of tubular epithelial cells reduces production of adenosine and induces vasodilation of the afferent arteriole. B: SGLT2 inhibitors restore solute delivery to the macula densa with resulting adenosine activation and reversal of vasodilation of the afferent arteriole. Reprinted with permission from Alicic RZ, et al. Diabetes. 2019;68:248–57.⁵⁴