A trial of finerenone in a patient with primary aldosteronism.

INTRODUCTION: Primary aldosteronism (PA), a common secondary cause of arterial hypertension, is treated either surgicaly, or pharmacologically with mineralocorticoid receptor antagonists (MRA). These drugs, while effective, can cause allergic reactions and have side-effects, including menstrual cycle disorders in women. Finerenone is a new, highly selective, nonsteroidal MRA with excellent side-effect profile, primarily intended to slow the progression of diabetic kidney disease and improve cardiovascular outcomes in these patients. No data are available data so far on its effect on patients with PA. CASE PRESENTATION: We present a case of a female patient with confirmed primary aldosteronism, in whom adrenal vein sampling failed twice. The patient developed a skin allergic reaction to spironolactone and experienced prolonged vaginal bleedings with eplerenone, which was attributed to the drug's affinity for progesterone receptors. A trial of finerenone was initiated, resulting in mild increase in plasma renin activity and serum potassium and somewhat control of blood pressure, but far from optimal blood pressure control, normokalemia or unsupression of plasma renin activity. CONCLUSION: This case highlights the challenges of managing PA and describes an attempt of treatment with finerenone to which this patient unfortunately did not adequately respond.

Residual Renal Function: A Double-Edged Sword.

INTRODUCTION: Nephrotic syndrome may persist despite end-stage kidney disease and result in dyslipidaemia, thrombosis and a significantly increased cardiovascular risk. Treatment of refractory nephrotic syndrome includes surgical bilateral nephrectomy, renal artery embolization and pharmacologic nephrectomy. CASE PRESENTATION: We present a case of a haemodialysis patient with refractory nephrotic syndrome who underwent pharmacologic nephrectomy. The procedure decreased the patient's cardiovascular risk and enabled the patient to become a candidate for kidney transplantation. CONCLUSION: In certain situations residual renal function may be harmful. In such instances, nephrectomy should be considered. Pharmacologic nephrectomy using nephrotoxic drugs is a non-invasive approach with least potential complications.

Association of anti-diabetic drugs and covid-19 outcomes in patients with diabetes mellitus type 2 and chronic kidney disease: Nationwide registry analysis.

INTRODUCTION: Patients with diabetes mellitus type 2 and chronic kidney disease (T2DM-CKD) have a 5 times higher risk of developing severe SARS-CoV-2 infection than those without these 2 diseases. The goal of this study is to provide information on T2DM-CKD and COVID-19 outcomes, with an emphasis on the association with anti-diabetic medications. METHODOLOGY: Study is designed as a retrospective cohort analysis covering the years 2020 and 2021. Data from the National Diabetes Registry (CroDiab) were linked to hospital data, primary healthcare data, Causes of Death Registry data, the SARS-CoV-2 vaccination database, and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome predictors, logistic regression models were developed. RESULTS: Of 231 796 patients with diabetes mellitus type 2 in the database, 7 539 were T2DM-CKD (3.25%). The 2-year cumulative incidences of all three studies' outcomes were higher in T2DM-CKD than in diabetes patients without CKD (positivity 18.1% vs. 14.4%; hospitalization 9.7% vs. 4.2%; death 3.3% vs. 1.1%, all p<0.001). For COVID-19 hospitalization, protective factors were SGLT-2 inhibitors use (OR 0.430; 95%CI 0.257-0.719) and metformin use (OR 0.769; 95% CI 0.643-0.920), risk factors were insulin use (1.411; 95%CI 1.167-1.706) and sulfonylureas use (OR 1.226; 95% CI 1.027-1.464). For SARS-CoV-2 positivity protective factors were SGLT-2 inhibitors (0.607; 95% CI 0.448-0.823), repaglinide use (OR 0.765; 95% CI 0.593-0.986) and metformin use (OR 0.857; 95% CI 0.770-0.994). DPP-4 inhibitors showed a non-significant decrease in risk for COVID-19 death (OR 0.761; 95% CI 0.568-1.019). CONCLUSION: T2DM-CKD are heavily burdened by COVID-19 disease. Our results suggest no association between antidiabetic drugs and COVID-19 death outcome while SGLT-2 and metformin show to be protective against COVID-19 hospitalization and infection, repaglinide against infection, and insulin and sulfonylureas show to be risk factors for COVID-19 hospitalization and infection. Further research in T2DM-CKD is needed.