In the past 10 years, many widely accepted concepts relating to
aldosterone production and its pathogenetic role have changed. We now know that
aldosterone is produced not only by the zona glomerulosa of the adrenal cortex, but also in the heart, blood vessels, kidney and brain; such extra-epithelial production occurs mainly during tissue repair. Also, increased
aldosterone levels contribute to vessel
inflammation, oxidative stress, endothelial dysfunction and organ damage. As such,
aldosterone has a key role in the development of myocardial
fibrosis. Anti-
aldosterone treatment has proven effective in patients with
heart failure. Experimental evidence regarding the role of
aldosterone in kidney damage has accumulated.
Aldosterone infusion can counteract the beneficial effects of treatment with
angiotensin-converting-enzyme inhibitors, causing more-severe
proteinuria and an increased number of vascular and glomerular lesions; treatment with
aldosterone antagonists can reverse these alterations. Preliminary observations in pilot studies in humans confirm the experimental findings, supporting the hypothesis that
aldosterone antagonists are renoprotective in clinical practice. Studies in larger populations with longer follow-up are needed to confirm this theory.