Acute Kidney Injury Associated With Finerenone Use in Type 2 Diabetes Mellitus Patients: A Case Report

Abstract Individuals with diabetes are at an increased risk of cardiovascular (CV) disease. The risk further increases in the presence of kidney involvement. Nonsteroidal mineralocorticoid receptor antagonist finerenone has shown beneficial effects on cardiorenal outcomes in type 2 diabetes mellitus (T2DM) and has been recommended by various guidelines for the reduction of chronic kidney disease progression and CV events. Here, we present an individual with T2DM and early renal insufficiency, who had acute worsening of renal parameters after finerenone therapy, which reverted back to baseline levels after the therapy was discontinued. A 58-year-old male with T2DM of 13 years duration presented with loss of appetite, weight loss of 4 kg during the last 6 months, cough for 1 week, fever with chills on and off for the last 1 month, and fluctuating blood sugars. Investigations revealed elevated renal parameters, uncontrolled blood sugars, hyperuricemia, anemia, eosinophilia, and hyperlipidemia. A nephrologist’s opinion was taken and, on his advice, conservative renal care was continued. Finerenone (10 mg) was initiated as a cardiorenal protective measure along with other supportive measures. After three doses of finerenone, there was a sudden worsening of the renal parameters. Blood urea increased from 73 to 100 mg/dL, serum creatinine increased from 1.7 to 4.7 mg/dL, and serum potassium from 4.3 to 5.4 mEq/L. After finerenone was stopped, along with good hydration and renal supportive measures, the renal parameters and serum potassium levels reverted back to baseline levels. Occasionally, finerenone may induce acute worsening of renal parameters. When initiating treatment with this drug, apart from repeating serum potassium, renal parameters may also need to be reassessed.