Calcium antagonists and acute renal failure.

Area of Science:

• Nephrology
• Pharmacology
• Cardiovascular Research

Background:

• Acute renal failure (ARF) following ischemia poses a significant clinical challenge.
• Calcium antagonists are a class of drugs with potential protective effects on renal function.

Purpose of the Study:

• To critically evaluate the efficacy of calcium antagonists in preventing or mitigating post-ischemic ARF.
• To review experimental and clinical evidence on verapamil, diltiazem, and nifedipine for ARF treatment.

Main Methods:

• Comprehensive literature search (1980-1988) for studies on calcium antagonists and post-ischemic ARF.
• Inclusion criteria and methodologic guidelines were used to select and evaluate studies.
• Focused on experimental models and clinical trials, including renal transplantation.

Main Results:

• Experimental studies showed protection of glomerular filtration rate (GFR) when calcium antagonists were given pre- and post-ischemia.
• In renal transplantation, diltiazem reduced delayed graft function but did not improve one-year graft survival.
• Current evidence does not establish superiority of one calcium antagonist over another for ARF.

Conclusions:

• Calcium antagonists show promise in preventing/reducing post-ischemic ARF when administered both before and after the ischemic event.
• These agents are most relevant in the context of renal transplantation, particularly for reducing delayed graft function.
• Further research is needed to understand why improved graft function does not translate to enhanced graft survival.