title: Aldosterone blockade in chronic kidney disease.
abstract: Although blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers has become standard therapy for chronic kidney disease (CKD), renewed interest in the role of aldosterone in mediating the injuries and progressive insults of CKD has highlighted the potential role of treatments targeting the mineralocorticoid receptor (MR). Although salt restriction is an important component of mitigating the profibrotic effects of MR activation, a growing body of literature has shown that MR antagonists, spironolactone and eplerenone, can reduce proteinuria and blood pressure in patients at all stages of CKD. These agents carry a risk of hyperkalemia, but this risk likely can be predicted based on baseline renal function and mitigated using dietary modifications and adjustments of concomitant medications. Data on hard outcomes, such as progression to end-stage renal disease and overall mortality, still are lacking in patients with CKD.
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Hirsch
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Drexler
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: asb68@columbia.edu.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
mesh_terms: D000450:Aldosterone / Q000502:physiology; D000818:Animals; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D018161:Receptors, Mineralocorticoid / Q000502:physiology; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000502:physiology
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid; D000450:Aldosterone
keywords: Aldosterone; chronic kidney disease; proteinuria; spironolactone