ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2026
The non-steroidal mineralocorticoid receptor blocker esaxerenone reduces glomerular hyperfiltration and albuminuria.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
backgroundDiabetic kidney disease (DKD) is a major cause of chronic kidney disease, with glomerular hyperfiltration contributing to its progression. Esaxerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), reduces albuminuria, but its precise mechanism remains unclear. Mineralocorticoid receptor (MR) activation is implicated in tubuloglomerular feedback (TGF) dysregulation, and we hypothesized that MR inhibition attenuates albuminuria by mitigating glomerular hyperfiltration.
methodsTo investigate the effects of esaxerenone, we used aldosterone-induced MR activation rats and type 2 diabetic (db/db) mice. In vivo multiphoton imaging was performed to assess the single-nephron glomerular filtration rate (SNGFR) and arteriolar diameters. Macula densa (MD) cells were used to examine MR activation's impact on TGF.
resultsIn aldosterone-infused rats, MR activation induced glomerular hyperfiltration via afferent arteriolar dilation, which was attenuated by esaxerenone. In db/db mice, esaxerenone reduced SNGFR and urinary albumin excretion while increasing urinary adenosine levels, effects reversed by A1aR blockade. In MD cells, MR activation increased nitric oxide (NO) production and reduced Na+-K+-2Cl- cotransporter membrane expression, both of which were mitigated by MRA or neuronal nitric oxide synthase inhibition.
conclusionThese findings suggest that esaxerenone restores TGF function via adenosine signalling, attenuating glomerular hyperfiltration and reducing albuminuria. This study provides novel insights into the albuminuria-lowering effects of MR blockade in DKD and supports the therapeutic potential of esaxerenone.
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