A 42-year-old woman comes to the physician for a follow-up examination. She has a history of type 2 diabetes mellitus and coronary artery disease. Current medications include metformin, aspirin, pravastatin, and losartan. Her body mass index is 30 kg/m2. Physical examination shows no abnormalities. Laboratory studies show a fasting glucose level of 156 mg/dL, serum creatinine of 1.1 mg/dL, hemoglobin A1c of 8.1%, and urine albumin-creatinine ratio of 200 mg/g (normal:

Question

A 42-year-old woman comes to the physician for a follow-up examination. She has a history of type 2 diabetes mellitus and coronary artery disease. Current medications include metformin, aspirin, pravastatin, and losartan. Her body mass index is 30 kg/m2. Physical examination shows no abnormalities. Laboratory studies show a fasting glucose level of 156 mg/dL, serum creatinine of 1.1 mg/dL, hemoglobin A1c of 8.1%, and urine albumin-creatinine ratio of 200 mg/g (normal: <30).  Treatment with empagliflozin is initiated.  Which of the following effects is most likely to be seen with this new treatment?

Quizplus · Accepted Answer

Eductional Objective: In patients with diabetes, excess glucose in the proximal tubule causes increased reabsorption of sodium by sodium-glucose cotransporter 2 (SGLT2).  This leads to decreased delivery of sodium to the macula densa and increased secretion of renin, ultimately increasing glomerular filtration pressure and causing hyperfiltration.  SGLT2 inhibitors increase the delivery of sodium to the macula densa, decreasing renin production and reducing hyperfiltration.

A 42-Year-Old Woman Comes to the Physician for a Follow-Up