Amlodipine effects on kidney function
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Amlodipine and Kidney Function: Protective Effects and Mechanisms
Protective Effects Against Drug-Induced Nephrotoxicity
Amlodipine has shown significant protective effects against various forms of drug-induced kidney injury. In animal studies, amlodipine reduced kidney damage caused by cisplatin, paracetamol, gentamicin, and methotrexate. It did this by lowering serum creatinine and blood urea nitrogen (BUN) levels, improving antioxidant defenses, and reducing markers of inflammation and cell death in the kidneys 15789. These effects were linked to the inhibition of harmful enzymes, activation of antioxidant pathways (such as Nrf2/HO-1), and suppression of inflammatory and apoptotic signaling 1578.
Amlodipine in Acute Kidney Injury and Ischemia/Reperfusion
Amlodipine also protected against acute kidney injury (AKI) caused by ischemia/reperfusion and contrast media. In rat models, it improved kidney function by reducing oxidative stress, inflammation, and tissue damage, while enhancing mitochondrial health and autophagy . In hypertensive patients, pretreatment with amlodipine before contrast exposure lowered the risk of contrast-induced AKI, reduced hospital stays, and improved overall survival .
Effects on Chronic Kidney Disease and Hypertensive Nephropathy
In studies involving hypertensive rats and patients with chronic kidney disease, amlodipine helped control blood pressure and slowed the progression of kidney damage. It reduced proteinuria and serum creatinine, and decreased the progression of histological kidney damage, with effects similar to those of ACE inhibitors like enalapril . In patients with type 2 diabetes and hypertension, amlodipine slowed the decline in glomerular filtration rate (GFR) to a degree comparable to ACE inhibitors, especially when blood pressure was well controlled .
Renal Hemodynamics and Fibrosis Markers
Amlodipine increased GFR in renal transplant patients by raising glomerular hydrostatic pressure and filtration fraction, but did not reduce levels of the fibrosis marker TGF-beta1, unlike angiotensin receptor blockers . This suggests that while amlodipine improves kidney blood flow, it may not directly reduce fibrotic processes in the kidney.
Limitations in Preventing Glomerular Injury
Some experimental studies found that although amlodipine lowers systemic blood pressure, it may not reduce glomerular pressure or prevent glomerular injury in certain models of hypertension. This indicates that its protective effects may be more pronounced in acute or toxin-induced kidney injury rather than in all forms of chronic hypertensive nephropathy .
Conclusion
Amlodipine demonstrates clear protective effects on kidney function in various settings, particularly in acute and drug-induced kidney injuries, by reducing oxidative stress, inflammation, and cell death. It is effective in controlling blood pressure and slowing kidney function decline in hypertensive and diabetic patients. However, its ability to prevent chronic glomerular injury may be limited compared to other antihypertensive agents. Overall, amlodipine is a valuable option for kidney protection, especially in patients at risk of acute kidney injury or those with hypertension and comorbidities.
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