Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
Front Endocrinol (Lausanne). 2023 Dec 20;14:1320603. doi: 10.3389/fendo.2023.1320603. eCollection 2023.
Diabetic kidney disease (DKD) is a common disorder with numerous severe clinical implications. Due to a high level of fibrosis and inflammation that contributes to renal and cardiovascular disease (CVD), existing treatments have not effectively mitigated residual risk for patients with DKD. Excess activation of mineralocorticoid receptors (MRs) plays a significant role in the progression of renal and CVD, mostly by stimulating fibrosis and inflammation. However, the application of traditional steroidal MR antagonists (MRAs) to DKD has been limited by adverse events. Finerenone (FIN), a third-generation non-steroidal selective MRA, has revealed anti-fibrotic and anti-inflammatory effects in pre-clinical studies. Current clinical trials, such as FIDELIO-DKD and FIGARO-DKD and their combined analysis FIDELITY, have elucidated that FIN reduces the kidney and CV composite outcomes and risk of hyperkalemia compared to traditional steroidal MRAs in patients with DKD. As a result, FIN should be regarded as one of the mainstays of treatment for patients with DKD. In this review, the safety, efficiency, and potential mechanisms of FIN treatment on the renal system in patients with DKD is reviewed.
糖尿病肾病（DKD）是一种常见的疾病，具有许多严重的临床意义。由于纤维化和炎症水平高，导致肾脏和心血管疾病（CVD），现有的治疗方法并没有有效地降低 DKD 患者的残余风险。过量激活盐皮质激素受体（MRs）在肾脏和 CVD 的进展中起着重要作用，主要通过刺激纤维化和炎症。然而，传统的甾体 MR 拮抗剂（MRAs）在 DKD 中的应用受到不良反应的限制。非甾体选择性 MRA 费列罗酮（FIN）在临床前研究中显示出抗纤维化和抗炎作用。目前的临床试验，如 FIDELIO-DKD 和 FIGARO-DKD 及其联合分析 FIDELITY，已经阐明 FIN 与传统甾体 MRA 相比，可降低 DKD 患者的肾脏和心血管复合结局以及高钾血症的风险。因此，FIN 应被视为 DKD 患者治疗的主要方法之一。在这篇综述中，我们回顾了 FIN 治疗 DKD 患者肾脏系统的安全性、疗效和潜在机制。
