Non-Steroidal Mineralocorticoid Receptor Antagonists: A Paradigm Shift in the Management of Diabetic Nephropathy
Open accessAbstract
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.
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There are two different classes of MRAs, steroidal and nonsteroidal, with one group not extrapolatable to the other.
“There are two different classes of MRAs, steroidal and nonsteroidal, with one group not extrapolatable to the other (142).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [142]
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11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s011 · Cited by 108 · see citing works
Emerging role of GLP-1RAs in the management of diabetic kidney disease
Bellary, S. (2025) · British Journal of Diabetes · doi:10.15277/bjd.2025.478
Strategies for the prevention and treatment of hypertension and recent advances
陳佳慧, Jiang, J., & Rui, X. (2026) · Letters in Drug Design & Discovery · doi:10.1016/j.lddd.2026.100650
- Authors
- Huart, J., & Jouret, F.
- Affiliations
- University of Liège (BE)
- Venue
- Kidney and Blood Pressure Research
- Publisher
- S. Karger AG
- Published
- 2025-03-17
- Volume
- 50
- Issue
- 1
- Pages
- 267-275
- ISSN
- 1420-4096 (ISSN-L)
- 1423-0143
- OpenAlex
- W4408567340
- Cited by
- 3
- References
- 45
- Citations by year
- 2026: 1 · 2025: 2
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Kidney & Blood Pressure Research (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Repository and Bibliography (University of Liège) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- finerenone, non-steroidal mineralocorticoid receptor antagonists, diabetic nephropathy, renin-angiotensin-aldosterone system inhibitors, SGLT2 inhibitors, proteinuria, renal protection, cardioprotection, combination therapy
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Mineralocorticoid Receptor Antagonists, Diabetic Nephropathies, Humans, Naphthyridines
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