{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:48:47Z","timestamp":1789397327493,"version":"build-2803163510"},"reference-count":85,"publisher":"Korean Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2021R1F1A1051955"],"award-info":[{"award-number":["2021R1F1A1051955"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["e-enm.org"],"crossmark-restriction":true},"short-container-title":["Endocrinol Metab"],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:p>Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), especially finerenone, have shown significant cardiorenal benefits in patients with chronic kidney disease (CKD). Clinical trials consistently report reductions in albuminuria and improved renal outcomes; however, the specific intrarenal hemodynamic mechanisms remain partially understood. nsMRAs lower albuminuria, a critical surrogate marker for CKD progression, with early reductions contributing significantly to renal benefits. These agents produce mild natriuretic effects by inhibiting aldosterone-mediated sodium reabsorption in the distal nephron, resulting in a slight reduction in extracellular volume. Additionally, nsMRAs may impact glomerular hemodynamics by mitigating aldosterone-induced constriction of the efferent arterioles and restoring tubuloglomerular feedback, while also modulating connecting tubule glomerular feedback. Collectively, these effects may contribute to lowering intraglomerular pressure and attenuating glomerular hyperfiltration. However, current evidence does not definitively show that nsMRAs are superior to steroidal mineralocorticoid receptor antagonists in correcting hyperfiltration. Their clinical benefits seem to arise from enhanced safety, tolerability, and sustained therapeutic use. This narrative review synthesizes existing clinical and experimental evidence on the intrarenal hemodynamic effects of nsMRAs, emphasizing their roles in sodium handling, natriuresis, and regulation of intraglomerular pressure.<\/jats:p>","DOI":"10.3803\/enm.2026.3093","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:48:51Z","timestamp":1781585331000},"page":"337-350","update-policy":"https:\/\/doi.org\/10.3803\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intrarenal Hemodynamic Mechanisms of Kidney Protection by Nonsteroidal Mineralocorticoid Receptor Antagonists"],"prefix":"10.3803","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1282-7876","authenticated-orcid":true,"given":"Eun Sil","family":"Koh","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5869-2734","authenticated-orcid":true,"given":"So Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2262-3253","authenticated-orcid":true,"given":"Doan Thi Thien","family":"Hao","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea"},{"name":"Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9886-8339","authenticated-orcid":true,"given":"Sungjin","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2119","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2025845","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2110956","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab777","type":"journal-article"},{"key":"ref4","first-page":"S117","volume-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","year":"2024","type":"journal-article"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3904\/kjm.2023.98.6.270","type":"journal-article"},{"key":"ref6","volume-title":"","year":"2025","type":"web-resource"},{"key":"ref7","first-page":"1475","type":"journal-article","volume-title":"Finerenone in heart failure with mildly reduced or preserved ejection fraction","author":"Solomon","year":"2024"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1097\/ms9.0000000000003995","type":"journal-article"},{"key":"ref9","first-page":"947","type":"journal-article","volume-title":"Finerenone in type 1 diabetes and chronic kidney disease","author":"Heerspink","year":"2026"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2604625","type":"journal-article"},{"key":"ref11","volume-title":"","year":"2026","type":"web-resource"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10081","type":"journal-article"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.030131","type":"journal-article"},{"key":"ref14","first-page":"15","type":"journal-article","volume-title":"Developments in albuminuria testing: a key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease: a practical update for clinicians","author":"Beernink","year":"2025"},{"key":"ref15","first-page":"32","type":"journal-article","volume-title":"Proteinuria or albuminuria as markers of kidney and cardiovascular disease risk: an individual patient-level meta-analysis","author":"Heerspink","year":"2026"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.2337\/figshare.20289009.v1","type":"journal-article"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-023-02413-2","type":"journal-article"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23169243","type":"journal-article"},{"key":"ref19","first-page":"1606","type":"journal-article","volume-title":"Impact of finerenone-induced albuminuria reduction on chronic kidney disease outcomes in type 2 diabetes: a mediation analysis","author":"Agarwal","year":"2023"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2020050723","type":"journal-article"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-021-01442-z","type":"journal-article"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2011.48","type":"journal-article"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2016020124","type":"journal-article"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2010.03.010","type":"journal-article"},{"key":"ref25","first-page":"1178","type":"journal-article","volume-title":"The role of 11b-hydroxysteroid dehydrogenase type 2 in human hypertension","author":"Ferrari","year":"2010"},{"key":"ref26","first-page":"101","type":"journal-article","volume-title":"Regulation of aENaC transcription","author":"Chen","year":"2015"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1172\/jci29850","type":"journal-article"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1210\/me.2007-0225","type":"journal-article"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.2001.281.4.c1118","type":"journal-article"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2013.267609","type":"journal-article"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2013060634","type":"journal-article"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-016-1798-5","type":"journal-article"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00352.2016","type":"journal-article"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.14","type":"journal-article"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00110.2003","type":"journal-article"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.29997","type":"journal-article"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbamcr.2013.05.009","type":"journal-article"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1159\/000091456","type":"journal-article"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.90217.2008","type":"journal-article"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpaic.2015.03.005","type":"journal-article"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.5049\/ebp.2021.19.2.38","type":"journal-article"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2022.115386","type":"journal-article"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.19159","type":"journal-article"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-015-0945-x","type":"journal-article"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.03.007","type":"journal-article"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2004.06.029","type":"journal-article"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.08020910","type":"journal-article"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.444","type":"journal-article"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145666","type":"journal-article"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpac124","type":"journal-article"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2025.2551","type":"journal-article"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1580645","type":"journal-article"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.19744","type":"journal-article"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-022-02282-3","type":"journal-article"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-019-0314-7","type":"journal-article"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.120.16397","type":"journal-article"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13010053","type":"journal-article"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1097\/01.asn.0000083982.74108.54","type":"journal-article"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.0000111138.78714.1a","type":"journal-article"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1161\/01.res.0000106135.02935.e1","type":"journal-article"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1016\/j.steroids.2007.12.010","type":"journal-article"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.31.1.451","type":"journal-article"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1210\/en.141.10.3871","type":"journal-article"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193032","type":"journal-article"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.111.173195","type":"journal-article"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00072.2014","type":"journal-article"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.6.2_pt_2.i183","type":"journal-article"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.0000105624.68174.00","type":"journal-article"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.0000205224.58715.cc","type":"journal-article"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1097\/mnh.0b013e32833ce6d5","type":"journal-article"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2014.04.006","type":"journal-article"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1038\/ncpneph0575","type":"journal-article"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.0438-17","type":"journal-article"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.m115.657957","type":"journal-article"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac284","type":"journal-article"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.34067\/kid.0007072021","type":"journal-article"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht187","type":"journal-article"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.5049\/ebp.2026.24.e3","type":"journal-article"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae027","type":"journal-article"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1681\/asn.0000001071","type":"journal-article"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1007\/s13340-025-00866-2","type":"journal-article"},{"key":"ref82","first-page":"379","type":"journal-article","volume-title":"Efficacy and safety of aldosterone synthase inhibition with and without empagliflozin for chronic kidney disease: a randomised, controlled, phase 2 trial","author":"Tuttle","year":"2024"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.25.126","type":"journal-article"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2025.10.004","type":"journal-article"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.23.194","type":"journal-article"}],"container-title":["Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-enm.org\/upload\/pdf\/enm-2026-3093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-enm.org\/journal\/view.php?doi=10.3803\/EnM.2026.3093","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-enm.org\/upload\/pdf\/enm-2026-3093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T09:39:31Z","timestamp":1782812371000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-enm.org\/journal\/view.php?doi=10.3803\/EnM.2026.3093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":85,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.3803\/enm.2026.3093","relation":{},"ISSN":["2093-596X","2093-5978"],"issn-type":[{"value":"2093-596X","type":"print"},{"value":"2093-5978","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"assertion":[{"value":"2026-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-16","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}