Kidney Week

Abstract: TH-PO0230

Balcinrenone, a Nonsteroidal Mineralocorticoid Receptor Antagonist, Attenuates Renal Fibrosis Through Modulation of TGF-β-Smad Signaling

Session Information

• CKD: Mechanisms of Injury and Fibrosis - 1
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2203 CKD (Non-Dialysis): Mechanisms

Authors

• Chung, Sungjin, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul, Korea (the Republic of)

Sungjin Chung, MD, PhD, FASN

• Lee, So Young, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul, Korea (the Republic of)

So Young Lee, MD

• Ryou, Seyoung, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul, Korea (the Republic of)

Seyoung Ryou, MD

• Hao, Doan Thi Thien, The Catholic University of Korea College of Medicine, Seocho-gu, Korea (the Republic of)

Doan Thi Thien Hao, MD, MS

• Koh, Eun Sil, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul, Korea (the Republic of)

Eun Sil Koh, MD, PhD

• Choi, Bumsoon, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul, Korea (the Republic of)

Bumsoon Choi, MD

Background

Chronic kidney disease (CKD) is characterized by progressive renal fibrosis, ultimately leading to end-stage kidney disease. Overactivation of the mineralocorticoid receptor (MR) contributes to renal fibrogenesis by promoting inflammation, myofibroblast activation, and extracellular matrix accumulation. Although steroidal mineralocorticoid receptor antagonists (MRAs) confer renoprotective effects, their clinical use is limited by adverse effects such as hyperkalemia. Balcinrenone is a novel tissue-selective, non-steroidal MRA with potential anti-fibrotic activity and a lower risk of electrolyte disturbances. This study investigated the therapeutic effects of balcinrenone in a murine unilateral ureteral obstruction (UUO) model of renal fibrosis.

Methods

Male mice subjected to sham or UUO surgery were orally treated with balcinrenone or vehicle throughout the experimental period. Renal fibrosis was assessed by histologic staining and molecular analyses.

Results

Balcinrenone treatment significantly attenuated tubulointerstitial fibrosis in UUO kidneys, as demonstrated by reduced collagen deposition on Masson’s trichrome and Sirius Red staining. Serum potassium levels did not differ significantly among groups, and systolic blood pressure showed a non-significant trend toward reduction in balcinrenone-treated UUO mice. Balcinrenone markedly decreased renal protein expression of α-smooth muscle actin (α-SMA), vimentin, and collagen IV. In addition, balcinrenone significantly reduced renal TGF-β1 and phosphorylated Smad2/3 expression without altering total Smad3 levels.

Conclusion

Balcinrenone ameliorated renal fibrosis in the UUO model, potentially through suppression of TGF-β/Smad signaling and myofibroblast activation. These findings suggest that balcinrenone may represent a promising therapeutic strategy for CKD-associated renal fibrosis with a favorable electrolyte safety profile.

Funding

• Government Support – Non-U.S.