Nephroprotection in metabolic syndrome: from control of individual symptoms to systemic therapy

Mikhailova L.V., Rafalsky V.V., Kryukova N.O., Tynterova A.M., Filimonkina I.A.

Immanuel Kant Baltic Federal University, Kaliningrad, Russia

This review focuses on the evolution of approaches to nephroprotection in patients with metabolic syndrome (MS). The authors trace the historical development of our understanding of the relationships between the components of MS (arterial hypertension, obesity, type 2 diabetes mellitus, dyslipidemia) and kidney damage leading to chronic kidney disease (CKD). The importance of transitioning from symptomatic treatment of individual manifestations of MS to systemic therapy aimed at addressing common pathogenetic mechanisms, such as IR, chronic inflammation, and activation of the renin-angiotensin-aldosterone system, is emphasized. The role of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor antagonists (ARBs) as primary nephroprotective agents is examined in detail. Their mechanism of action is mediated through their effect on intraglomerular hemodynamics. Particular attention is paid to the role of sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) in current clinical guidelines. The article discusses the unique properties of SGLT2 inhibitors, which are associated to their proven nephroprotective and cardioprotective effects in both diabetic and nondiabetic CKD. It is concluded that early initiation of comprehensive nephroprotective therapy and multidisciplinary patient management by cardiologists, endocrinologists, and nephrologists are necessary to improve prognosis. The review points to the potential for expanding the arsenal of drugs that systemically target various components of the pathogenesis of metabolic syndrome.

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About the Authors

Larisa V. Mikhailova – Cand.Sci. (Med.), Associate Professor, Head of the Department of Therapy, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University. Address: 60 9th April st., Kaliningrad; Tel.: +7 (4012) 59-55-95, ext. 6709; E-mail: mihalysa@mail.ru. ORCID: 0000-0001-5070-5955
Vladimir Vitalievich Rafal'skiy – Dr.Sci. (Med.), Professor, Head of the Department of General and Clinical Pharmacology, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University. Address: 60 9th April st., Kaliningrad; Tel.: +7 (4012) 59-55-95, ext. 6709; e-mail: v.rafalskiy@mail.ru. ORCID: 0000-0002-2503-9580
Nadezhda O. Kryukova – Cand.Sci. (Med.), Associate Professor, Department of General and Clinical Pharmacology, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University. Address: 60 9th April st., Kaliningrad; Tel.: +7 (4012) 59-55-95, ext. 6709; e-mail: krukovano@yandex.ru. ORCID: 0000-0002-2379-6764
Anastasia M. Tynterova – Dr.Sci. (Med.), Associate Professor, Department of Psychiatry and Neurosciences, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University. Address: 60 9th April st., Kaliningrad; Tel.: +7 (4012) 59-55-95 ext. 6709; E-mail: antynterova@mail.ru. ORCID: 0000-0003-1743-4713
Iuliia A. Filimonkina – Teaching Assistant, Department of Therapy, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University.
Address: 60 9th April st., Kaliningrad; tel: + 7 (4012) 59-55-95, ext. 6709; e-mail: j.filimonkina@mail.ru. ORCID: 0009-0000-1864-2448

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