Aldosterone in renal disease.
OBJECTIVE
Interruption of the renin-angiotensin-aldosterone system, chiefly with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, has yielded beneficial results in retarding injury and progression in numerous intrinsic renal diseases. The renoprotection offered by these agents is incomplete and far from optimal. Studying mediators of progression other than angiotensin II is therefore extremely important. The emerging role of aldosterone in progression of renal disease and the utility of its antagonism is discussed here.


RESULTS
The experimental evidence linking aldosterone to renal disease is discussed. The exciting results from clinical studies employing mineralocorticoid receptor blockers are also described.


CONCLUSIONS
Aldosterone antagonism offers additional antiproteinuric benefits to those achieved with angiotensin-converting enzyme inhibition. Long-term trials addressing effectiveness and safety, especially in regards to hyperkalemia, are greatly needed.
Ibrahim
Hassan N
HN
Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis 55455, USA. ibrah007@umn.edu
Hostetter
Thomas H
TH
D000450:Aldosterone / Q000378:metabolism*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004195:Disease Models, Animal; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000175:diagnosis; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D007677:Kidney Function Tests; D011507:Proteinuria / Q000175:diagnosis / Q000517:prevention & control*; D012084:Renin-Angiotensin System; D018570:Risk Assessment
D000806:Angiotensin-Converting Enzyme Inhibitors; D000450:Aldosterone