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Update in Nephrology
- Stanley Goldfarb, MD; and
- William L. Henrich, MD
- From the University of Pennsylvania Health System, Philadelphia, Pennsylvania; and Medical College of Ohio, Toledo, Ohio. Requests for Reprints: Stanley Goldfarb, MD, Department of Medicine, University of Pennsylvania Health System, 100 Centrex, 3400 Spruce Street, Philadelphia, PA 19104-4283. Current Author Addresses: Dr. Goldfarb: Department of Medicine, University of Pennsylvania Health System, 100 Centrex, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Renal disease remains a prevalent and costly problem in the United States. The treatment of end-stage renal disease costs at least $11 billion a year. Both diabetes and drugs are common causes of renal failure, and much research has recently been done in these areas. Great attention has also been focused on the prevention of renal disease, an important endeavor for every physician.
Diabetic Renal Disease
In 1996, two studies showed that calcium-channel blockers may have an important role in preventing renal failure in diabetic patients. Another study found that progression of renal disease in type 1 diabetes mellitus parallels that in type 2 diabetes mellitus.
Calcium-Channel Blocker Improved Glomerular Filtration Rate
Mosconi L, Ruggenenti P, Perna A, Mecca G, Remuzzi G. Nitrendipine and enalapril improve albuminuria and glomerular filtration rate in non-insulin dependent diabetes. Kidney Int. 1996; 49:S91-3.
Evidence clearly shows that angiotensin-converting enzyme (ACE) inhibitors delay the onset of nephropathy in patients with type 1 diabetes. Data increasingly indicate that ACE inhibitors are similarly efficacious in patients with type 2 disease [1, 2]. Some authors have suggested that calcium-channel blockers may also have a role in preventing renal disease in diabetic patients [3]. Mosconi and colleagues evaluated the relative ability of both classes of drugs to prevent nephropathy, particularly in patients with type 2 diabetes.
Sixteen patients with type 2 diabetes, microalbuminuria (urinary albumin excretion rate, 20 to 200 mg/d), hypertension, and biopsy-proven diabetic nephropathy were recruited. All patients stopped receiving antihypertensive therapy for 2 weeks and received placebo for 1 month. The 13 patients who complied with this protocol were entered into a trial in which they were given nitrendipine, a calcium-channel blocker (dosage titrated to a maximum of 20 mg twice daily), or enalapril, an ACE inhibitor (maximum dosage, 10 mg twice daily). (Nitrendipine is a short-acting dihydropyridine that has not yet been …
