.png)
Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
Stay sharp, stay current, and stay confident with Brilliant Medicine — the go-to podcast for Internal Medicine and Family Medicine physicians, residents, nurse practitioners, and physician assistants.
Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
🩺 Fast. Practical. Evidence-based.
This is the update your medical brain craves.
Brilliant Board Review & CME
🎙️ Episode 32: SGLT2 vs Kidney Stones: A Surprising Win
🧪 Key Findings:
Cohort study: SGLT2 inhibitors led to significantly lower rates of nephrolithiasis compared to GLP-1 RAs.
Mechanism: increased urinary flow and uric acid excretion.
🔢 Stats:
NNT = 20 for prevention.
NNT = 5 for recurrent stone formers.
🧩 Clinical Takeaway:
Another bonus benefit of SGLT2 inhibitors.
May sway decision in diabetics prone to stones.
HCTZ no longer holds the same weight in stone prevention.
Now let's talk about SGL2s having a lower risk for recurrent nephrotisosis. And why is that important? Well, kidney stones cost the US economy billions of dollars a year. Have you ever had a loved one and or yourself have a kidney stone? You will understand the immense pain and suffering that someone has. You'll understand the immense pain and suffering that someone has, plus the loss of work and loss of school and ability to carry out even basic functions for a period of time because of the pain. In fact, if you talk to people who've had pregnancies and deliveries and then you ask them if this same person who's had kidney stones and they'll tell you the kidney stone is much more painful than giving birth. Now you may argue with that. It's multiple discussions that I've had in literature I've read. So this is a cohort study moving forward with patients either getting SGL-2 or DLP-1s they're both great drugs or GLP-1s they're both great drugs. But we do know the SGL-2 co-transfer to inhibitors promote uric acid excretion and urinary flow and it lowers the risk of kidney stones and gout attacks. So in this study they fought for the patients for about 1.3 years and what they noticed was somebody and it was 14,000 the sgl2 inhibitors and glp1. It was 6 000 glp1 agnes and they went in patient years, thousand patient years, and it was 156 verse 103, which was a very significant in reduction of nephrolithiasis. Number needed to treat was 20. Especially if the patient had recurrent nephrolithiasis it was number to treat was five. So think we talked about all these great things that SDSGL2s can do if they can take away kidney stones.
Speaker 1:Now let's go back and take a step back. I know you were taught in medical school. I know you were taught in your lectures. I know you were taught and you can still find it. Hydrochlorothiazides they actually do not do a good job for preventing nephropathiasis. I know you were taught this. I know it's still in the textbooks. The literature is coming out. They don't do as great a job. Yes, in theory they should, but in reality they don't. So this is another reason to kind of think of the SGL2s. What is the main problem with the SGL2s? Costs, costs, as we talked about, the costs, costs, costs. But as the costs come down, this is going to start becoming a front line. And remember the hydrochlorothiazides. I want it to work, but it doesn't work in reducing nephrothiazides. Look at the literature.