PURPOSE OF REVIEW: We aim to review the mechanism of action and safety profile 
of mineralocorticoid receptor antagonists (MRAs) and discuss the differences 
between selective and non-selective MRAs. More specifically, finerenone is a new 
medication that is currently under investigation for its promising 
cardiovascular and nephrological effects.
RECENT FINDINGS: MRAs are well known for their utility in treating heart 
failure, refractory hypertension, and diverse nephropathies, namely, diabetic 
nephropathy. As their name denotes, MRAs inhibit the action of aldosterone at 
the mineralocorticoid receptor, preventing receptor activation. This prevents 
remodeling, decreases inflammation, and improves proteinuria. There are not 
significant differences in outcomes between selective and non-selective MRAs. A 
new selective MRA named finerenone (originally BAY 94-8862) has shown promising 
results in several trials (ARTS-HF and ARTS-DN) and smaller studies. Finerenone 
may have a dose-dependent benefit over older MRAs, decreasing rates of 
albuminuria and levels of BNP and NT-ProBNP without causing a significant 
increase in serum potassium levels. This medication is not yet approved as it is 
still in phase 3 clinical trials (FIGARO-DKD and FIDELIO-DKD trials). MRAs are 
beneficial in several disease states. Newer medications, such as finerenone, 
should be considered in patients with heart failure and diabetic nephropathy who 
may benefit from a reduction in albuminuria and BNP/NT-ProBNP. Data surrounding 
finerenone are limited to date. However, results from ongoing clinical trials, 
as well as new trials to evaluate use in other pathologies, could validate the 
implementation of this medication in daily practice.