Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Aldosterone Inhibition on Proteinuria in Patients With Progressive Renal Disease
Brief Summary: The purpose of this study is to examine whether the inhibition of aldosterone will result in lower excretion of protein via urine. The hypothesis is that if loss of protein is lowered, progression of renal disease with be slower than otherwise expected.


Options:
A: Inclusion Criteria:

* Age ≥ 18 years
* Taking at least three medications for blood pressure (one a diuretic)
* Uncontrolled high blood pressure
* Abnormal kidney function (with-eGFR, a measure of kidney function, of 25 - ≤ 45 mL/min/1.73m2
* Normal Blood serum Potassium in a specific range (4.3 - 5.1 mEq/L)

Exclusion Criteria:

* History of untreated known causes of high blood pressure, excluding kidney disease (not CKD)
* Inability to measure BP
* Not taking high blood pressure medications as prescribed medications
* Recent change in renal function (in the past 3 months) which has required hospitalization or dialysis
* Renal transplant
* History of cancer within past 12 months
* Recent cardiovascular event with last 3 months
* Clinically significant abnormalities of heart rhythm (ventricular arrhythmia or atrial fibrillation with uncontrolled heart rate)
* Inability to take study medication
* Alcoholism
B: Inclusion Criteria:

* Proteinuria \> 500 mg/24 hours
* Hypertension or anti-hypertensive treatment

Exclusion Criteria:

* Diabetic nephropathy
* GFR\< 20 ml/min
* P-potassium between 3,5 mmol/l and 5,0 mmol/l
C: Inclusion Criteria:

* Men aged 18 years and older or postmenopausal women aged 55 years and older or women aged 18 years and older without childbearing potential based on surgical treatment such as bilateral tubal ligation, bilateral ovarectomy, or hysterectomy
* Clinical diagnosis of CHF (chronic heart failure), either ischemic or non-ischemic, NYHA (New York Heart Association) class II - III, treated with evidenced-based therapy for CHF, e.g. beta-blockers and ACE (angiotensin-converting enzyme) inhibitors or ARB (angiotensin receptor blocker) as well as diuretics, unless contraindicated or not tolerated
* Known kidney damage for \>/= 3 months, as defined by structural or functional abnormalities of the kidney, and

  * Part A: 60 mL/min/1.73 m\*2 \</= eGFR (estimated Glomerular Filtration Rate) \< 90 mL/min/1.73 m\*2 (MDRD, Modification of Diet in Renal Disease) at the screening visit
  * Part B: 30 mL/min/1.73 m\*2 \</= eGFR \<= 60 mL/min/1.73 m\*2 (MDRD) at the screening visit
* Serum potassium \</= 4.8 mmol/L at the screening visit
* Systolic blood pressure \>/= 90 mmHg without signs or symptoms of hypotension at the screening visit

Exclusion Criteria:

* Known hypersensitivity to the study drug (active substance or excipients) or spironolactone and respective excipients (Part B only)
* Subjects with anuria, acute renal failure, or Addison's disease
* Acute coronary syndrome or unstable coronary artery disease within 30 days prior to randomization
* Valvular heart disease requiring surgical intervention during the course of the study
* History of hospitalization for hyperkalemia or acute renal failure induced by previous aldosterone antagonist treatment
D: Inclusion Criteria:

* Male or female patient ≥21 years old
* Admitted to hospital for AHF with at least 1 symptom (dyspnea, orthopnea, or fatigue) and 1 sign (rales on auscultation, peripheral edema, ascites, pulmonary vascular congestion on chest radiography) of congestion
* Patient must be randomized within 24 hours of first IV diuretic dose administered for the current episode of decompensation (regardless of where the diuretic was given e.g. office, ED, ambulance, hospital etc.)
* Estimated GFR of ≥30 mL/min/1.73m2 determined by the MDRD equation
* Serum K+ ≤5.0 mmol/L at enrollment
* NT-proBNP ≥1000 pg/mL or BNP ≥250 pg/mL, measured within 24h from randomization
* Not on MRA or on low-dose spironolactone (12.5 mg or 25 mg daily) at baseline

Exclusion Criteria:

* Taking eplerenone or \>25 mg spironolactone at baseline
* eGFR \< 30 ml/min/1.73m2
* Serum K+ \>5.0 mmol/L. If a repeat measurement within the enrollment window is \<5.0, the patient can be considered for inclusion.
* Systolic blood pressure \<90 mmHg
* Hemodynamically significant arrhythmias or defibrillator shock within 1 week
* Acute coronary syndrome currently suspected or within the past 4 weeks
* Severe liver disease (ALT or AST \>3 x normal, alkaline phosphatase or bilirubin \>2x normal)
* Active infection (current use of oral or IV antimicrobial agents)
* Active gastrointestinal bleeding
* Active malignancy other than non-melanoma skin cancers
* Current or planned mechanical circulatory support within 30 days
* Post cardiac transplant or listed for transplant and expected to receive one within 30 days
* Current inotrope use
* Complex congenital heart disease
* Primary hypertrophic cardiomyopathy, infiltrative cardiomyopathy, acute myocarditis, constrictive pericarditis or tamponade
* Previous adverse reaction to MRAs
* Enrollment in another randomized clinical trial during index hospitalization

Answer: B