Research Progress on the Mechanism and Clinical Efficacy of Finerenone in the Treatment of Diabetic Nephropathy

Corresponding author: CAO Yanxia, 2317461232@qq.com

DOI: 10.12201/bmr.202607.00028

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  Abstract: Diabetic kidney disease (DKD) is the main microvascular complication of type 2 diabetes. It is a significant cause of end-stage renal disease and adverse cardiovascular events. Its pathological mechanism is closely related to inflammatory response, oxidative stress, endothelial dysfunction and metabolic disorders. Currently, there are no effective targeted drugs available in clinical practice to improve the prognosis of patients with DKD in terms of heart and kidney health.Excessive activation of mineralocorticoid receptors is a key factor in the progression of DKD. The third-generation non-steroidal mineralocorticoid receptor antagonist, finerenone, improves cardiovascular and renal outcomes through multiple mechanisms such as anti-inflammation, anti-fibrosis, and regulation of metabolism. It has become a current research hotspot in the treatment of DKD. This article systematically reviews the new progress in basic and clinical research on non-nalidronate treatment for DKD in recent years, elaborates on its molecular mechanisms of regulating renal pathological damage and intervening in metabolic signaling pathways, deeply explores its anti-inflammatory, anti-oxidative stress, and anti-fibrotic mechanisms, and combines multiple clinical trial data from both domestic and international sources to comprehensively evaluate the clinical efficacy and safety of non-nalidronate in the treatment of DKD. Existing studies have confirmed that finerenone not only reduces proteinuria and delays the decline of renal function, but also significantly reduces the risk of cardiovascular events. The drug has good tolerance and manageable adverse reactions. In conclusion, nelarabine breaks through the limitations of traditional DKD treatment and provides a new strategy for achieving dual benefits for the heart and kidneys. Its clinical application prospects are broad. However, more large-sample, long-term follow-up real-world studies are still needed in the future to further clarify individualized medication regimens for different populations, improve the evidence system for its long-term efficacy and safety, and promote its standardized application in clinical practice.

  Key words: Finerenone; Diabetic nephropathy; Mechanisms;   Inflammation; fibrosis

  Submit time: 21 July 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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