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[Nephro-protective effect of calcium antagonists]
1Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Insights
Calcium antagonists are crucial for managing hypertension in chronic renal failure and kidney transplant patients. They effectively reduce proteinuria in diabetic nephropathy, offering nephroprotective benefits, especially when combined with CEIs.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Context:
- Hypertension management is vital in chronic renal failure to prevent kidney function decline.
- Kidney transplant recipients benefit from calcium antagonists due to their ability to mitigate cyclosporine-induced kidney ischemia.
- Diabetic nephropathy patients show reduced proteinuria with calcium antagonists, comparable to CEIs.
Purpose:
- To elucidate the role and mechanisms of calcium antagonists in renal protection.
- To evaluate the efficacy of calcium antagonists in chronic renal failure, kidney transplantation, and diabetic nephropathy.
- To explore the nephroprotective effects and mechanisms of calcium antagonists.
Summary:
- Calcium antagonists are essential for controlling hypertension in chronic renal failure, preserving renal function.
- In kidney transplant recipients, these drugs attenuate cyclosporine's ischemic effects on the kidney.
- Nifedipine and other calcium antagonists lower proteinuria in diabetic nephropathy; combination therapy with CEIs offers synergistic benefits and reduced side effects.
Impact:
- Calcium antagonists play a significant role in preserving kidney function and managing hypertension in diverse renal conditions.
- The findings support the use of calcium antagonists as a cornerstone therapy in nephrology, particularly in combination regimens.
- Understanding the intraglomerular hemodynamic effects of calcium antagonists enhances nephroprotection strategies.
Abstract:
ACTION OF CALCIUM ANTAGONISTS: In patients with chronic renal failure, controlling hypertension is an integral part of the therapeutic scheme aimed at preventing further degradation of renal function. Hypertension accelerates such degradation and inversely the renal disease aggravates hypertension. Normal blood pressure is thus crucial. Several studies have elucidated the action of calcium antagonists in these patients. KIDNEY TRANSPLANT RECIPIENTS: Calcium antagonists have several highly favorable effects on the transplanted kidney. These effects are explained by the attenuation of the ischemic effects of cyclosporin on the kidney. These patients should be given a calcium antagonist which does not raise the serum level of cyclosporin. DIABETIC NEPHROPATHY: In acute regimens, all calcium antagonists do not appear to have the same effect in patients with diabetic nephropathy. With the notable exception of nifedipine, calcium antagonists can lower acute proteinuria in these patients. Three controlled sudies conducted for more than 6 months have shown that the proteinuria lowering effect of calcium antagonists is equivalent to that of CEIs. Combined CEI and a calcium antagonist is probably the prescription of choice for these patients. Besides the antihypertensive synergism, this combination reduces the side effects of each class prescribed alone. In addition, there is experimental evidence supported by several clinical trials showing an improved nephroprotector effect compared with single prescription of each drug class alone. MECHANISMS OF NEPHROPROTECTION: Chronic renal failure results form intricated hemodynamic and cellular mechanisms. A lower intraglomerular hydrostatic pressure is a crucial element in nephroprotection. All the intrarenal effects of calcium antagonists have not been identified. Certain effects concern preglomerular vasodilatation alone while others have pre- and post-glomerular effects and thus have a potentially greater nephroprotector effect.