Abstract:

Abjective　To investigate the efficacy and safety of finerenone in combination with renin-angiotensin-aldosterone system inhibitors （RAASi） and dapagliflozin in patients with primary membranous nephropathy （PMN）. Methods A total of 40 patients with PMN were randomly assigned to the treatment group （finerenone + RAASi + dapagliflozin） and the control group （RAASi + dapagliflozin）， with 20 patients in each group. Clinical indicators， such as 24-hour urinary protein， endogenous creatinine clearance rate， serum creatinine， serum albumin， and serum potassium， were collected at 0， 1， 3， and 6 months of treatment to compare the efficacy and adverse reactions between the two groups. Results The 24-hour urinary protein levels decreased in both groups when compared to the baseline. At the 1-month mark， the 24-hour urinary protein in the treatment group was lower than that in the control group， though the difference was not statistically significant （P > 0.05）. However， at 3 and 6 months， the 24-hour urinary protein in the treatment group was significantly lower than that in the control group （P < 0.05）. At 6 months， the serum albumin in the treatment group was significantly higher than that in the control group （P < 0.05）， while at 1 and 3 months， it was higher but without statistical significance （P > 0.05）. Throughout all time points， there were no significant differences in serum creatinine and endogenous creatinine clearance rate between the two groups （P > 0.05）. The incidence of adverse events was 40% in the treatment group and 35% in the control group. The difference was not statistically significant （P > 0.05）， and no serious adverse events were reported. Conclusion Finerenone， when combined with RAASi and dapagliflozin， can effectively reduce proteinuria and maintain stable renal function in patients with PMN， and it has good safety.

Key words: primary membranous nephropathy, finerenone, 24-hour urinary protein, renin-angiotensin-aldosterone system inhibitor, dapagliflozin