Sodium glucose cotransporter 2 inhibitors (SGLT2i) are currently available for the management of type 2 diabetes mellitus. SGLT2i act by inhibiting renal SGLT2, thereby increasing glucosuria and lowering serum glucose. Recent trials are emerging supporting a role for SGLT2i irrespective of the diabetic status pointing towards that SGLT2i have other mechanisms of actions beyond blood sugar control. In this review, we will shed light on the role of this group of medications that act as SGLT2i in non-diabetics focusing on pre-clinical and clinical data highlighting the mechanism of renoprotection and effects of SGLT2i in the non-diabetic kidneys.

Diabetic kidney disease (DKD) is the major cause of chronic kidney disease (CKD) and increases the risk of cardiovascular events. Hemodynamic, inflammatory and metabolic factors, which share the convergent pathway of fibrosis, are considered to involve in the pathogenesis of DKD. In spite of the emerging of angiotensin receptors blockers (ARBs)/ angiotensin converting enzyme inhibitor (ACEI), sodium-glucose cotransporter 2 (SGLT2) inhibitors, and nonsteroidal mineralocorticoid receptors antagonists (NS-MRAs), current therapies still couldn’t arrest the progression of DKD. Glucagon like peptide 1 receptor agonists (GLP-1RAs) are promising agents to play renoprotective roles in slowing the progression of DKD. Based on the treatment of heart failure, combined use of drugs is recommended for DKD rather than single use. Unearthing the mechanisms underlying DKD is urgent to investigate the management of DKD. Here, we elaborate on the potential mechanisms and the current therapies of DKD. We also discuss the additional value of the combined use of these drugs for DKD to establish novel concepts of treatment.