MR over-activation leads to a series of renal pathological changes, including glomerular basement membrane thickening, podocyte injury, mesangial cell proliferation and apoptosis, mesangial expansion, macrophage infiltration, collagen deposition, glomerulosclerosis, renal tubular epithelial cell atrophy and renal interstitial fibrosis, renal tubular inflammation, endothelial dysfunction, and arteriosclerosis ( Finerenone, which is a nonsteroidal mineralocorticoid antagonist (MRA), is the only nonsteroidal MRA clinically proven to have renal and cardiovascular benefits ( 5.4 Endothelin receptor antagonists The expression of endothelin-1 (ET-1) is increased in the kidney of patients with DKD (Zhang et al., 2023
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Tirzepatide (Mounjaro/Zepbound) Tirzepatide is another injectable weight-loss medication that targets two hormone receptors (GLP-1 and GIP), potentially leading to higher weight loss than semaglutide