Possible Protective Effect of Finerenone Against Radiocontrast-Induced AKI

Introduction: The pathogenic mechanism of radiocontrast induced AKI has not been elucidated. Barrera-Chimal J, et al demonstrated protective effects of Finerenone in mice against AKI mediated by ischemia-reperfusion (Kidney International 93(6):1344-1355.2017). Case Description: A 41 year old non-diabetic female CKD V with stable serum creatinine of 6 mg% and eGFR of 8 had been treated with Finerenone 20mg daily for 3 years in effort to slow progression of CKD secondary to thrombotic microangiopathy suffered 5 years prior. Patient received radiocontrast for cardiac catheterization. Serum creatinine checked 7 days after procedure was 5.5 mg%. Discussion: It is extraordinarily unusual for administration of contrast agent to a patient with stage V CKD not to cause worsening of eGFR. Finerenone may have abrogated the hemodynamic effects of aldosterone and protected the patient from contrast agent induced AKI.