Nephrol Dial Transplant (1989) 4: 1030-1036
© 1989 European Renal Association-European Dialysis and Transplant Association
research-article
Prevention of Radiocontrast-Media-Induced Nephrotoxicity by the Calcium Channel Blocker Nitrendipine: A Prospective Randomised Clinical Trial
1Department of Internal Medicine and Nephrology, Klinikum Steglitz, Freie Universität Berlin 2Laboratory Institute Kiel, FRG
Correspondence and offprint requests to: Correspondence and offprint requests to: Professor Dr Hans-Hellmut Neumayer, Transplantationszentrum, University of Erlangen-Nürnberg 4, Medizinische Klinik, Kontumazgarten 14-18, 8500 Nürnberg, FRG
Despite the development of new non-ionic lowosmolality contrast media, nephrotoxicity of intravascular radio-opaque contrast media remains a severe clinical problem, particularly in patients with risk factors. Widely accepted mechanisms of contrast-media-induced nephrotoxicity are disturbances of renal microcirculation due to prolonged intrarenal vasoconstriction, and direct damaging effects on glomerular and tubular cells. Calcium channel blocking agents have been shown experimentally and clinically to ameliorate ischaemic and toxic renal injury. In the present prospectively randomised, double-blind clinical trial, we investigated a total of 35 patients after intravascular administration of contrast media to determine the effects on renal function of a 3-day treatment with the calcium channel blocker nitrendipine (20 mg/day orally, starting 1 day before X-ray examination, n = 16), compared to findings in a placebo-treated control group (n = 19). Despite the fact that baseline renal function was significantly more compromised in the investigational group, the prophylactic application of nitrendipine preserved the glomerular filtration rate, whereas control patients showed a significant (27%) reduction in GFR on day 2 after contrast-media injection (P
0.01). Moreover, the increase in enzymuria of three different renal enzymes (
-GT, AAP, and ß-NAG), as well as urinary protein excretion, was significantly ameliorated by nitrendipine. These data confirm previous findings of our group in patients after kidney transplantation, indicating that prophylactic and/or therapeutic application of calcium channel blockers is of substantial value in preventing ischaemic or toxic renal injury.
In addition to its positive effects on renal haemodymamics, nitrendipine may also exert a so-called cytoprotective influence, inhibiting intracellular calcium overload and thus improving mitochondrial respiration. As already demonstrated by others, the non-nephrotoxic superiority of the newer non-ionic, low-osmolality contrast materials is not entirely uncontested.
Keywords: Calcium channel blocker; Enzymuria; Glomerular filtration rate; Nephrotoxicity; Proteinuria; Radiocontrast media
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