Differences in glomerular membrane permeability responses to a non-dihydropyridine (NDHP) and dihydropyridie (DHP) calcium channel antagonist (CCA) in patients with diabetic nephropathy:
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:118A 1997
Unlike their nondihydropyridine counterparts, dihydropyridine calcium channel blockers do not reduce proteinuria in diabetic nephropathy, but the mechanism of these differences remains unclear. 28 patients with Type II diabetes and nephropathy were randomized to either once daily diltiazem CD (D) or nifedipine XL (N). Goal MAP was <107 mmHg and patients were followed for 2 years. GFR, RBF, dextran permeability, HBA1c, and 24h urine protein, sodium, and creatinine were determined every 4 mo. D decreased proteinuria from 908 to 389 mg/d, whereas there was no change with N (873 to 904 mg/d). D reduced pore shunting of protein whereas N increased shunting. No differences in the other parameters were noted between the 2 groups. D reduces proteinuria by decreasing glomerular membrane permeability.
Comment: These data further demonstrate marked differences in renal effects of calcium antagonists. There were similar slight (not significant) increases in RBF after calcium blockade in both groups. However, increases in RBF were quantitatively similar for both D and N; these studies thus do not suggest that N has a greater renal vasodilatory effect. (David J. Leehey, M.D., Loyola University at Chicago)
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ASN 30th Annual Meeting, San Antonio
H: Pathophysiology : Kidney in hypertension
Proteinuria/Hematuria : Diabetes