Nephrol Dial Transplant (2003) 18: 1984-1992
© 2003 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Aldosterone receptor blockade and the role of eplerenone: evolving perspectives
Department of Medicine, University of Miami, School of Medicine, Miami, FL, USA
Correspondence and offprint requests to: Murray Epstein, MD, Professor of Medicine, Nephrology Section, VA Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA. Email: murraye@gate.net
Keywords: aldosterone; cardiovascular disease; eplerenone; mineralocorticoid receptor; renal disease; selective aldosterone blockade
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Introduction
Aldosterone is a major regulator of extracellular fluid volume and the major determinant of potassium metabolism [1–5]. These effects are mediated by the binding of aldosterone to the mineralocorticoid receptor in target tissues, primarily the kidney. Volume is regulated through a direct effect on the collecting duct, where aldosterone causes an increase in sodium retention and an increase in potassium excretion. The reabsorption of sodium ions produces a fall in the transmembrane potential, thus enhancing the flow of positive ions, such as potassium, out of the cell into the lumen. The reabsorbed sodium ions are transported out of the tubular epithelium into the renal interstitial fluid and from there into the renal capillary circulation.
Three primary mechanisms control aldosterone release: the renin–angiotensin system, potassium and adrenocorticotropic hormone. The renin–angiotensin system controls extracellular fluid volume via regulation of aldosterone secretion. In effect, the renin–angiotensin system maintains the
Traditional concept
Non-classic actions of aldosterone
Cardiovascular effects
The role of aldosterone in mediating progressive renal disease
Are the adverse effects of aldosterone produced indirectly by altering sodium and potassium?
Mechanisms by which aldosterone promotes fibrosis and target organ disease
Aldosterone blockade mitigates renal disease: clinical studies
Limitations of non-selective aldosterone receptor blockade
Selective aldosterone blockade
Summary
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