Mineralocorticoid receptor (MR) antagonists, for example, spironolactone and 
eplerenone, are in clinical use to treat hypertension. Increasing evidence 
suggests that mineralocorticoid receptor activation causes the pathogenesis and 
progression of chronic kidney disease. Aldosterone-induced MR activation 
increases inflammation, fibrosis, and oxidative stress in the kidney. MR 
antagonists (MRAs) have demonstrated therapeutic actions in chronic kidney 
disease (CKD), diabetic nephropathy (DN), renal fibrosis, and drug-induced renal 
injury in preclinical and clinical studies. We have summarized and discussed 
these studies in this review. The nonsteroidal MRA, esaxerenone, recently 
received approval for the treatment of hypertension. It has also shown a 
positive therapeutic effect in phase 3 clinical trials in patients with DN. 
Other nonsteroidal MRA such as apararenone, finerenone, AZD9977, and LY2623091 
are in different clinical trials in patients with hypertension suffering from 
renal or hepatic fibrotic diseases. Hyperkalemia associated with MRA therapy has 
frequently led to the discontinuation of the treatment. The new generation 
nonsteroidal MRAs like esaxerenone are less likely to cause hyperkalemia at 
therapeutic doses. It appears that the nonsteroidal MRAs can provide optimum 
therapeutic benefit for patients suffering from kidney diseases.