# Finerenone vermindert albuminurie en beschermt hart en nier bij CKD

*geplaatst 2026-10-13 · Nierziekte · Cardiorenal medicine · doi 10.1159/crm/abtag001 · https://hartvaat.nl/2026/10/05/finerenone-vermindert-albuminurie-en-beschermt-hart-en-nier-bij-ckd/*

Deze narratieve review beschrijft de klinische effecten en werkingsmechanismen van finerenone bij patiënten met chronische nierziekte (CKD) en residual albuminurie ondanks RAAS- of SGLT2-remmertherapie. Het middel vermindert albuminurie, vertraagt de progressie van nierfalen en verlaagt het cardiovasculaire risico, met een gunstiger hyperkaliëmieprofiel dan steroïde MRAs; de renale bescherming wordt versterkt in combinatie met bestaande nier- en hartbeschermende therapieën. Voor de klinische praktijk biedt dit overzicht een onderbouwd kader voor het inzetten van finerenone in cardiorenale zorg, met de kanttekening dat grote RCTs nodig zijn voor niet-diabetische CKD-patiënten en optimale combinatiestrategieën.

## English: Finerenone in Reducing Proteinuria: Clinical Effects, Underlying Mechanisms, and Associated Cardiorenal Protection.

This narrative review synthesizes clinical evidence and mechanisms of finerenone as an antiproteinuric agent in patients with chronic kidney disease (CKD), particularly those with residual albuminuria despite RAAS or SGLT2 inhibitor therapy. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, reduces albuminuria, slows kidney disease progression, and lowers cardiovascular risk, with a lower hyperkalemia incidence than steroidal MRAs; its renal benefits are enhanced when combined with RAAS blockers or SGLT2 inhibitors. For clinical practice, this review provides a structured overview of finerenone’s role in cardiorenal care, while highlighting the need for large-scale RCTs to confirm efficacy in non-diabetic CKD and optimize combination regimens.

## Abstract (original, from the publication)

Proteinuria remains a cardinal surrogate of renal injury and cardiorenal risk, However, residual albuminuria is commonly observed after the treatment with renin-angiotensin-aldosterone system (RAAS) blockade or sodium-glucose cotransporter-2 inhibitors (SGLT2i). The non-steroidal, selective mineralocorticoid receptor antagonist(MRA) finerenone has recently been demonstrated to possess albuminuria-lowering and organ-protective effects, Nonetheless, its precise mechanisms of action and the full scope of its benefits within combination drug regimens require further elucidation. This review comprehensively synthesizes the clinical evidence for finerenone as an antiproteinuric agent in chronic kidney disease (CKD) and summarizes its potential mechanisms of action. Finerenone acts as an inverse agonist by binding to the mineralocorticoid receptor, thereby concurrently suppressing both genomic and non-genomic aldosterone signaling. This action inhibits pro-fibrotic, pro-inflammatory, and hemodynamic pathways that collectively contribute to damage of the glomerular filtration barrier, ultimately leading to the observed alleviation of proteinuria. Clinical studies have confirmed that finerenone reduces albuminuria, slows the progression of kidney failure, and decreases the risk of cardiovascular events, with a lower incidence of hyperkalemia compared to steroidal MRAs. Regarding combination therapies, the renal protective effects of finerenone are enhanced when used concomitantly with either RAAS blockers or SGLT2 inhibitors. However, its clinical benefits in non-diabetic CKD populations remain to be substantiated by large-scale studies. Furthermore, the mechanisms underlying its intrarenal hemodynamic protection require further elucidation, and the optimal combination strategies and the underlying mechanisms for the potential benefits of such regimens await validation through large-scale, randomized controlled trials.

Auteurs: He Chen, Ling Xu, Dan Zhu

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Bron: Cardiorenal medicine, https://doi.org/10.1159/crm/abtag001. Bijgewerkt 2026-10-06T01:21:04Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.