Amlodipine and kidneys
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Amlodipine and Kidney Health: A Comprehensive Overview
Introduction to Amlodipine and Kidney Function
Amlodipine, a calcium channel blocker, is widely used to manage hypertension and angina. Its effects on kidney function have been the subject of numerous studies, particularly in patients with chronic kidney disease (CKD) and those who have undergone renal transplantation. This article synthesizes the findings from various research studies to provide a clear understanding of how amlodipine impacts renal health.
Amlodipine in Renal Transplant Recipients
Serum Creatinine and Renal Plasma Flow
In normotensive renal transplant recipients, amlodipine has been shown to significantly reduce serum creatinine levels, indicating improved kidney function. A study involving 27 patients demonstrated that amlodipine reduced serum creatinine concentration from 177 to 168 micromol/l (P=0.002) and showed a trend towards increased effective renal plasma flow, although glomerular filtration rate (GFR) and lithium clearance remained unaffected.
Hyperuricaemia and Hypertension
Amlodipine also appears to mitigate cyclosporin A (CsA)-induced hyperuricaemia in hypertensive renal transplant recipients. In a study comparing amlodipine with tertatolol, amlodipine significantly decreased serum uric acid levels and increased GFR and uric acid clearance, while tertatolol increased uric acid levels. This suggests that amlodipine may be more effective in managing CsA-induced side effects.
Amlodipine in Chronic Kidney Disease
Proteinuria and Blood Pressure Control
In patients with proteinuric CKD and hypertension, amlodipine was compared with losartan in a 12-month study. While both drugs were effective in controlling blood pressure, losartan significantly reduced urinary protein excretion, whereas amlodipine did not affect proteinuria levels. This indicates that while amlodipine is effective for blood pressure management, it may not provide the same level of renal protection as losartan in reducing proteinuria.
Renal Hemodynamics and Vascular Resistance
Amlodipine has been shown to improve renal hemodynamics by increasing GFR and renal plasma flow, and decreasing renal vascular resistance in hypertensive patients. These effects are attributed to its ability to antagonize the intrarenal effects of angiotensin II and norepinephrine, which are known to constrict blood vessels within the kidneys.
Experimental Models and Renal Protection
Glomerular Injury and Fibrosis
In experimental models of hypertension, amlodipine reduced systemic blood pressure but did not significantly affect glomerular filtration rate, proteinuria, or glomerular injury in hypertensive rats. However, in isolated perfused kidney models, amlodipine reversed angiotensin II-induced decreases in GFR, suggesting a protective effect on glomerular function.
Renal Interstitial Fibrosis
Amlodipine has also been studied for its effects on renal interstitial fibrosis. In a mouse model of unilateral ureteral obstruction, amlodipine reduced the expression of fibrosis markers and ameliorated renal interstitial fibrosis by inhibiting the phosphorylation of c-jun-N-terminal kinase (JNK).
Clinical Implications and Overall Survival
Contrast-Induced Acute Kidney Injury
Amlodipine has shown protective effects against contrast-induced acute kidney injury (CI-AKI) in hypertensive patients. A large cohort study found that pre-treatment with amlodipine reduced the incidence of CI-AKI and was associated with shorter hospital stays and improved overall survival.
Vascular Function and Remodeling
In a genetic hypertensive rat model of CKD, amlodipine improved vascular function and remodeling in resistance arteries, reducing blood pressure and plasma creatinine levels, and improving endothelial function. These findings suggest that amlodipine can positively impact vascular health in CKD patients.
Conclusion
Amlodipine demonstrates significant benefits in managing hypertension and improving certain aspects of renal function, particularly in renal transplant recipients and hypertensive patients. However, its effects on proteinuria and long-term renal protection may be less pronounced compared to other antihypertensive agents like losartan. Further research is needed to fully understand the scope of amlodipine's renoprotective effects and its role in comprehensive kidney care.
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