[Nephro-protective effect of calcium antagonists].
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.
Deray
G
G
Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière, Paris.
D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D006977:Hypertension, Renal / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000188:drug therapy*
D002121:Calcium Channel Blockers