Society of Diabetic Nephropathy Prevention Journal of Nephropathology 2251-8363 12 1 2023 01 01 Administration of finerenone in chronic kidney disease e17355 e17355 10.34172/jnp.2022.17355 EN Mohsen Akhavan Sepahi https://orcid.org/0000-0002-0499-8475 Elham Emami https://orcid.org/0000-0002-7573-6800 Akshaya Ann Joseph https://orcid.org/0000-0002-2628-852X Shakiba Hassanzadeh https://orcid.org/0000-0002-5091-5191 Mohammad Reza Razavi https://orcid.org/0000-0002-3990-1135 REVIEW 10.34172/jnp.2022.17355 2021 10 13 2022 01 03 Spironolactone is a first-generation and non-selective mineralocorticoid receptor antagonist (MRA). It is extensively well-studied and recommended due to increased accessibility for patients. Unfortunately, it is often discontinued in several cases due to its association with hyperkalemia. The apparent benefit of eplerenone over spironolactone is its mineralocorticoid receptor (MR) selectivity. However, it is also characterized by low-potency and higher cost compared to spironolactone. The high adverse-effect profile of spironolactone and eplerenone has led to the innovation of novel medications such as non-steroidal MRAs. Among these medications, finerenone is the most advanced agent. Finerenone is associated with decreased proteinuria, reduced risk of hyperkalemia and increased preservation of renal function with comparable benefit in heart failure compared to selective and nonselective MRAs. The nonsteroidal structure of finerenone affects mineralocorticoid receptor binding, lipophilicity and polarity which have potent effects on distribution, the degree of attachment to blood proteins, transportation, and tissue diffusion.