Nephrology Dialysis Transplantation, Vol 12, Issue 11 2244-2250, Copyright © 1997 by Oxford University Press
N Tarif and G Bakris
The vast majority of animal data derived from models of either remnant
kidney or diabetes demonstrate that dihydropyridine (nifedipine-like)
calcium-channel blockers (DHPCCBs) effectively reduce arterial pressure but
do not significantly affect proteinuria nor prevent development of
glomerular scarring. Conversely, the non-DHPCCBs such as diltiazem and
verapamil blunt both the rise in proteinuria as well as mesangial matrix
expansion and subsequent glomerular scarring in diabetics. Additionally,
the non-DHPCCBs markedly attenuate development of glomerular scarring in
the remnant kidney model. The primary reasons for these differences between
subclasses of CCBs relates to a lack of the following attributes by
DHPCCBs: (1) they fail to reduce glomerular membrane permeability which is
increased in these models; (2) they fail to affect the synthesis of certain
key matrix proteins that perpetuate development of glomerular scarring
(this effect may be due to the differential expression of calcium channels
within the glomerular mesangium); and (3) the DHPCCBs totally abolish renal
autoregulation in these models, an effect not observed with non-DHPCCBs.
Taken together with long-term (<3 year) clinical studies, primarily
in diabetic nephropathy, it is clear that the non-DHPCBs seem to offer
protection to the kidney not available with DHPCCBs alone, unless systolic
arterial pressure is reduced to levels of ⩽110 mmHg. Key
words: calcium-channel blockers; glomerular filtration rate;
albuminuria; proteinuria; hypertension; glomerulosclerosis
PERSONAL OPINION
Preservation of renal function: the spectrum of effects by calcium-channel blockers
Nephrology Division, University of Illinois Medical Center at Chicago, USA; The Rush University Hypertension Center, Chicago, Illinois, USA; Corresponding author at: Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, 1725 W. Harrison Street, Suite # 117, Chicago IL 60612, USA
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