TOPIC DISCUSSION: The return of "Spironolactone"

The mineralocorticoid receptor antagonists have been forgetten the world of ACEI and ARBCS in past decade. Sometimes, when used for hypertension, have done wonders in many pateints and they come of significant number of drugs.  What is the role of aldosterone in CKD and can the antagnosits retard CKD?
Aldosterone has a potential role in progression of CKD via vasoconstriction, oxidative stress, inflammmation, alteration of filtration barrier and perhaps direct glomerulosclerosis based on some initialy proposed mechanisms.  There is some lab data in certain kidney diseases like diabetic nephropathy, cyclosporine nephrotoxicity, proteinuric nephropathies and esrd even that these antagonists might be of some benefit.

There is growing interest in studing combination of RAAS blockade agents and above agents but concern always is hyperkalemia and that has prevented large trials.  More careful studies need to be done and clinical trials to show effect of these old, cheap but powerful agents that might just work.

Ref:
http://www.ncbi.nlm.nih.gov/pubmed/21412221