Non-Steroidal Mineralocorticoid Receptor Antagonists: A Paradigm Shift in the Management of Diabetic Nephropathy.

Diabetic nephropathy; Finerenone; Mineralocorticoid receptor antagonist; Non-steroidal structure; Mineralocorticoid Receptor Antagonists; finerenone; Naphthyridines; Sodium-Glucose Transporter 2 Inhibitors; Humans; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use; Diabetic Nephropathies/drug therapy; Mineralocorticoid Receptor Antagonists/therapeutic use; Mineralocorticoid Receptor Antagonists/pharmacology; Naphthyridines/therapeutic use; Naphthyridines/pharmacology; receptor antagonist; · Mineralocorticoid; Diabetic Nephropathies; Nephrology; Cardiology and Cardiovascular Medicine

Abstract :

[en] [en] BACKGROUND: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease worldwide. The management of DKD relies on controlling glycemia and blood pressure levels, as well as reducing proteinuria. While the traditional renin-angiotensin-aldosterone system inhibitors (RAASi) and the recently approved type 2 Na+/glucose co-transporter inhibitors (SGLT2i) have significantly improved patient outcomes, residual risks remain unaddressed. SUMMARY: This review explores (1) the mechanisms of action of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist (ns-MRA), (2) the evidence of finerenone-induced kidney protection in clinical trials, and (3) the comparative advantages over conventional MRAs. The potential synergy between finerenone and SGLT2i is also addressed, alongside research perspectives and practical considerations for implementation in clinical practice. KEY MESSAGES: Finerenone has emerged as a breakthrough therapy in the management of DKD, demonstrating robust nephro- and cardio-protective effects.

Disciplines :

Urology & nephrology

Author, co-author :

Huart, Justine ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie

Jouret, François ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie

Language :

English

Title :

Non-Steroidal Mineralocorticoid Receptor Antagonists: A Paradigm Shift in the Management of Diabetic Nephropathy.

Publication date :

2025

Journal title :

Kidney and Blood Pressure Research

ISSN :

1420-4096

eISSN :

1423-0143

Publisher :

S. Karger AG, Switzerland

Volume :

Issue :

Pages :

267 - 275

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://karger.com/article-pdf/doi/10.1159/000545286

Available on ORBi :

since 02 June 2025

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