Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Endocrinol Metab (Seoul). 2023 Feb;38(1):43-55. doi: 10.3803/EnM.2022.1629. Epub 2023 Feb 27.
Chronic kidney disease (CKD) is the most common cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). CKD increases the risk of cardiovascular diseases; therefore, its prevention and treatment are important. The prevention of diabetic kidney disease (DKD) can be achieved through intensive glycemic control and blood pressure management. Additionally, DKD treatment aims to reduce albuminuria and improve kidney function. In patients with T2DM, renin-angiotensin-aldosterone system inhibitors, sodium glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can delay the progression of DKD. Hence, there is a need for novel treatments that can effectively suppress DKD progression. Finerenone is a first-in-class nonsteroidal mineralocorticoid receptor antagonist with clinically proven efficacy in improving albuminuria, estimated glomerular filtration rate, and risk of cardiovascular events in early and advanced DKD. Therefore, finerenone is a promising treatment option to delay DKD progression. This article reviews the mechanism of renal effects and major clinical outcomes of finerenone in DKD.
慢性肾脏病（CKD）是 2 型糖尿病（T2DM）患者终末期肾病的最常见病因。CKD 增加了心血管疾病的风险；因此，预防和治疗都很重要。通过强化血糖控制和血压管理可以预防糖尿病肾病（DKD）。此外，DKD 的治疗旨在减少蛋白尿并改善肾功能。在 T2DM 患者中，肾素-血管紧张素-醛固酮系统抑制剂、钠-葡萄糖共转运蛋白 2 抑制剂和胰高血糖素样肽-1 受体激动剂可延缓 DKD 的进展。因此，需要新的治疗方法来有效抑制 DKD 的进展。非奈利酮是一种首创的非甾体类盐皮质激素受体拮抗剂，在改善白蛋白尿、估算肾小球滤过率和早期及晚期 DKD 心血管事件风险方面具有临床疗效。因此，非奈利酮是一种有前途的治疗选择，可以延缓 DKD 的进展。本文综述了非奈利酮在 DKD 中的肾脏作用机制和主要临床结局。
