How the kidney hyperfiltrates in diabetes: From molecules to hemodynamics

Figure 5 Compared to normal condition (left), ultrafiltrate in Bowman capsule contains significant amount of glucose in diabetes (middle). Because proximal tubules reabsorb more sodium with glucose through SGLT in diabetes (1), the delivery to macula densa is decreased (2). This weakens TGF signals to increase glomerular filtration rate (3), accounting for hyperfiltration in early stage of diabetes. Either GLP or SGLT inhibition (right) inhibits proximal tubular reabsorption (1), restoring sodium chloride delivery to macula densa even under hyperglycemic condition (2). This would have TGF work and normalize glomerular filtration rate (3), ameliorating glomerular hyperfiltration. SGLT: Sodium glucose co-transporter; GLP: Glucagon-like peptide; TGF: Tubuloglomerular feedback.