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Finerenone as a Third-Line Therapy for Persistent Proteinuria in Diabetic Kidney Transplant Recipients
Carmine Secondulfo1, Dora Russo2, Nicoletta Vecchione2
1Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.
International Journal of Molecular Sciences
|June 12, 2026
Summary
Finerenone, a non-steroidal mineralocorticoid receptor antagonist, reduced proteinuria in kidney transplant recipients (KTRs) without impacting graft function. This study suggests finerenone is a safe option for KTRs with persistent proteinuria.
Area of Science:
- Nephrology
- Pharmacology
- Transplantation
Background:
- Proteinuria predicts graft failure in kidney transplant recipients (KTRs).
- Non-steroidal mineralocorticoid receptor antagonists (NS-MRAs) show renoprotective effects in chronic kidney disease, but KTRs were excluded from trials.
- Limited evidence exists on finerenone's safety and efficacy in KTRs.
Purpose of the Study:
- To evaluate the safety and antiproteinuric effects of finerenone in diabetic KTRs with persistent proteinuria.
- To assess changes in proteinuria, albuminuria, and graft function (eGFR) after adding finerenone to standard therapy.
Main Methods:
- Retrospective observational study of 13 diabetic KTRs on optimized therapy.
- Finerenone (10 mg/day) added to standard care.
- Assessment of clinical and laboratory parameters at baseline, 3, and 6 months, focusing on proteinuria and safety (hyperkalemia, eGFR).
Main Results:
- Finerenone was discontinued in one patient due to hyperkalemia.
- In 12 patients, 24-h proteinuria and urinary protein-to-creatinine ratio decreased by 3 months and stabilized by 6 months.
- No significant changes in albuminuria, eGFR, blood pressure, or electrolytes were observed.
Conclusions:
- Finerenone was well-tolerated in this cohort of diabetic KTRs.
- Finerenone demonstrated an early reduction in proteinuria with no adverse effects on graft function.
- These findings suggest a potential role for finerenone in managing proteinuria in kidney transplant recipients.
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