The necessity and effectiveness of mineralocorticoid receptor antagonist in the treatment of diabetic nephropathy

Hypertension Research : Official Journal of the Japanese Society of Hypertension
Atsuhisa Sato

Abstract

Diabetes mellitus is a major cause of chronic kidney disease (CKD), and diabetic nephropathy is the most common primary disease necessitating dialysis treatment in the world including Japan. Major guidelines for treatment of hypertension in Japan, the United States and Europe recommend the use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, which suppress the renin-angiotensin system (RAS), as the antihypertensive drugs of first choice in patients with coexisting diabetes. However, even with the administration of RAS inhibitors, failure to achieve adequate anti-albuminuric, renoprotective effects and a reduction in cardiovascular events has also been reported. Inadequate blockade of aldosterone may be one of the reasons why long-term administration of RAS inhibitors may not be sufficiently effective in patients with diabetic nephropathy. This review focuses on treatment in diabetic nephropathy and discusses the significance of aldosterone blockade. In pre-nephropathy without overt nephropathy, a mineralocorticoid receptor antagonist can be used to enhance the blood pressure-lowering effects of RAS inhibitors, improve insulin resistance and prevent clinical progression of nephropathy. In CKD catego...Continue Reading

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Citations

Jan 29, 2016·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Kouichi TamuraSatoshi Umemura
Aug 11, 2016·Metabolism: Clinical and Experimental·Pingping YangGaosi Xu
Jun 6, 2016·The Journal of Investigative Dermatology·Van Tuan NguyenFrederic Jaisser
Oct 14, 2016·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Takashi KuwanoKeijiro Saku
Oct 21, 2016·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Shigeru ShibataShunya Uchida
Oct 21, 2016·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Naro OhashiHideo Yasuda
Apr 28, 2017·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Hisashi Kai
Jul 7, 2017·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Ali Nehme, Kazem Zibara
Nov 18, 2018·Current Clinical Pharmacology·Luxitaa GoenkaMelvin George
Jun 21, 2021·Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences·Qiuyang HuangLi Ma

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