[Aldosterone and kidney damage: clinical implications].

In addition to data regarding its effects on the heart, brain and blood vessels, extensive evidence has emerged about the contribution of aldosterone to kidney damage. This has mainly been studied in the setting of experimental models of salt-sensitive hypertension but has been confirmed also in other animal models. The evidence is supported by a clear causal relationship between aldosterone infusion and development of kidney damage and its reversal after aldosterone blockade. Since 2001, clinical data have been obtained on the antiproteinuric effect of aldosterone antagonists added to ACE inhibitors or angiotensin II receptor blockers. Unfortunately, the long-term findings are still scanty, except for those obtained in two one-year studies. Altogether, this therapeutic approach appears relatively safe and effective; however, larger studies on patients with a wider range of chronic kidney disease severities and longer follow-up are needed to confirm it.