Aldosterone and diabetic kidney disease

Aldosterone plays an important role in salt and water homeostasis and blood pressure control through the classical mineralocorticoid receptor. However, recent findings of the mineralocorticoid receptor in nonepithelial tissues suggest that aldosterone may have additional functions. Significant evidence now exists suggesting that aldosterone directly induces tissue injury. Systemic or local aldosterone has emerged as a multifunctional hormone exhibiting profibrotic and proinflammatory actions that extend beyond the classical hemodynamic effect. The incomplete blockade of the renin-angiotensin-aldosterone system by angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has led to experimental and clinical efforts using aldosterone inhibition. Recently, these efforts have provided us with an expanded understanding of a new pathogenic role for aldosterone in diabetic vascular complications. This article focuses on the role of aldosterone in the pathogenesis of diabetic kidney disease and recent important clinical data supporting the inhibition of aldosterone in treating diabetic kidney disease.