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Review
. 2024 Mar 26;17(4):418.
doi: 10.3390/ph17040418.

Finerenone: From the Mechanism of Action to Clinical Use in Kidney Disease

Nejc Piko  1 , Sebastjan Bevc  2   3 , Radovan Hojs  2   3 , Robert Ekart  1   3
Affiliations
Review

Finerenone: From the Mechanism of Action to Clinical Use in Kidney Disease

Nejc Piko et al. Pharmaceuticals (Basel). .

Abstract

Diabetic kidney disease is a frequent microvascular complication of diabetes and is currently the leading cause of chronic kidney disease and end-stage kidney disease worldwide. Although the prevalence of other complications of diabetes is falling, the number of diabetic patients with end-stage kidney disease in need of kidney replacement therapy is rising. In addition, these patients have extremely high cardiovascular risk. It is more than evident that there is a high unmet treatment need in patients with diabetic kidney disease. Finerenone is a novel nonsteroidal mineralocorticoid receptor antagonist used for treating diabetic kidney disease. It has predominant anti-fibrotic and anti-inflammatory effects and exhibits several renal and cardiac protective effects. This review article summarizes the current knowledge and future prospects of finerenone in treating patients with kidney disease.

Keywords: chronic kidney disease; diabetes; finerenone.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Main components in the development of diabetic kidney disease. Combined, several metabolic changes, glomerular hyperfiltration, inflammation, and fibrosis contribute to the development of diabetic kidney disease. Additional novel mechanisms include altered gut microbiota (gut–kidney axis) and genetic factors. Legend: AGEs—advanced glycation end products; NFκB—nuclear factor κB; ROS—reactive oxygen species; IL-18—interleukin 18; IL-1β—interleukin-1β; MR—mineralocorticoid receptor; NO—nitric oxide; AT II—angiotensin II; TXA 2—thromboxane 2.
Figure 2
Figure 2
The comparison between steroidal mineralocorticoid receptor antagonists (spironolactone and eplerenone) and finerenone [58]. Legend: MRA—mineralocorticoid receptor antagonist; MR—mineralocorticoid receptor; CNS—central nervous system.
Figure 3
Figure 3
Finerenone in diabetic kidney disease—most critical clinical trials [67,68,69,73,74,75]. Legend: CKD—chronic kidney disease.
See this image and copyright information in PMC

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