Amlodipine and kidney function
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Amlodipine and Kidney Function: A Comprehensive Review
Introduction to Amlodipine and Kidney Function
Amlodipine, a calcium channel blocker, is widely used to manage hypertension. Its effects on kidney function have been the subject of numerous studies, particularly in patients with renal impairments or those undergoing renal transplantation. This article synthesizes the findings from various research papers to provide a clear understanding of how amlodipine impacts kidney function.
Amlodipine in Renal Transplant Recipients
Hypertension and Hyperuricaemia Management
In renal transplant recipients, cyclosporin A (CsA) often induces hypertension and hyperuricaemia. A study comparing amlodipine and tertatolol found that amlodipine significantly reduced serum uric acid levels and increased glomerular filtration rate (GFR) and uric acid clearance, making it a preferable option for managing CsA-induced side effects . Additionally, amlodipine effectively lowered systolic blood pressure more than tertatolol, without affecting renal plasma flow or CsA blood concentration .
Normotensive Renal Transplant Recipients
For normotensive renal transplant recipients, amlodipine has shown beneficial effects on renal function. A study demonstrated that amlodipine significantly reduced serum creatinine levels and showed a trend towards increasing effective renal plasma flow, indicating improved renal function without affecting blood pressure or heart rate .
Amlodipine in Hypertensive Patients
Essential Hypertension
In patients with essential hypertension, amlodipine has been shown to increase GFR and renal plasma flow by antagonizing the effects of angiotensin II and norepinephrine. This results in decreased renal vascular resistance and improved renal function . Another study confirmed that amlodipine could reverse renal abnormalities associated with hypertension, such as increased renal vascular resistance and reduced renal blood flow .
Chronic Kidney Disease (CKD)
In a genetic hypertensive rat model of CKD, amlodipine treatment reduced blood pressure, plasma creatinine levels, and improved vascular structural parameters. However, it did not affect the biomechanical properties of the arteries, indicating that while amlodipine improves some aspects of renal function, it may not address all underlying issues in CKD .
Comparative Studies with ACE Inhibitors
Long-term Renoprotection
A one-year study comparing amlodipine with an angiotensin-converting enzyme inhibitor (ACEI), enalapril, found that both drugs had comparable effects on renal function in hypertensive patients with renal impairment. Amlodipine was better tolerated, with fewer patients dropping out due to adverse events, suggesting it as a viable alternative to ACEIs for long-term renoprotection .
Renal Hemodynamics
In hypertensive patients with renal impairment, amlodipine was shown to significantly reduce blood pressure and urinary protein excretion, similar to enalapril. However, the mechanisms of action differ, as amlodipine does not significantly dilate the efferent arteriole, unlike enalapril .
Molecular Mechanisms and Combined Therapies
PI3K/AKT Pathway
A study investigating the molecular mechanisms of amlodipine combined with traditional Chinese medicine found that this combination effectively reduced blood pressure and improved renal function. The treatment regulated the expression of the PI3K/AKT pathway, which is associated with improved renal biochemical indices and reduced pathological changes in renal tissue .
Conclusion
Amlodipine has demonstrated significant benefits in managing hypertension and improving renal function in various patient populations, including renal transplant recipients and those with chronic kidney disease. Its ability to reduce serum creatinine, increase GFR, and improve renal plasma flow makes it a valuable therapeutic option. Comparative studies with ACE inhibitors suggest that amlodipine is equally effective and better tolerated, providing a promising alternative for long-term renoprotection. Further research into its molecular mechanisms and combined therapies could enhance its efficacy in treating renal dysfunction.
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