الفهرس 
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Abstract
There has been much recent interest in the role of aldosterone as an independent contributor to the progression of chronic kidney disease and heart diease.
Despite treatment with agents such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, many studies have shown that there is incomplete blockade of the reninangiotensin cascade evidenced by persistent or rising plasma aldosterone levels despite therapeutic reninangiotensin blockade. This phenomenon is commonlyreferred to as “aldosterone escape”.
Aldosterone mediates the insertion of epithelial sodium channels in the collecting duct of the nephron and reabsorption of sodium and water. In instances of aldosterone hyperactivity, systemic hypertension can develop secondary to increased volume and salt reabsorption, leading to an increase in glomerular hydrostatic pressure, progressive glomerulosclerosis, increased afterload, and left ventricular dysfunction.
Aldosterone also initiates fibrosis by promoting reactive oxygen radical formation . The deposition of collagen and proliferation of fibroblasts alter the functional units of affected organs, thereby potentially altering normal physiologic organ function.
Spironolactoneis a non selective aldosterone antagonist that has been available for clinical use since the early 1970s. Initially licensed for the treatment of hypertension, primary hyperaldosteronism, peripheral edema and hypokalemia, spironolactone is relatively poorly tolerated. Problems with its administration relate mainly to its lack of specificity for the mineralocorticoid receptor.
The lack of specificity for the mineralocorticoid receptor with spironolactone prompted the search for more specific compounds in the hopes of being able to block the mineralocorticoid receptor without having to contend with the burden of side-effects seen with spironolactone . Thus, the molecule eplerenone , the first selective aldosterone receptor antagonist, gained U.S. approval for the treatment of hypertension inSeptember 2002.
In 2007, eplerenone, a selective aldosterone blocker, became clinically available in Japan. Currently, eplerenone is indicated for heart failure in more than 60 countr