Nitrendipine and amlodipine mimic the acute effects of enalapril on renal haemodynamics and reduce glomerular hyperfiltration in patients with chronic kidney disease.

Abstract

Antihypertensive drugs may have an important effect on glomerular haemodynamics. In chronic nephropathy patients, we compared the effect on glomerular haemodynamics of two second-generation dihydropyridinic agents, nitrendipine and amlodipine, with a first generation dihydropyridinic agent and an ACE-inhibitor, enalapril. In all, 32 patients (pts), divided into four groups, received the different drugs: ENA (enalapril, eight pts), NIF (nifedipine, eight pts), NIT (nitrendipine, eight pts) AML (amlodipine, eight pts). The study assessed the effect on glomerular haemodynamics of a single administration of the test drug in baseline conditions and in glomerular hyperfiltration experimentally induced by amino-acid infusion. The glomerular filtration rate (GFR, measured by inulin clearance), effective renal plasma flow (ERPF, measured by p-aminohippurate clearance), renal vascular resistances (RVR) and filtration fraction (FF) were assessed. Administration of AML and NIT test dose reduced FF, as did ENA, but not NIF, in both baseline (AML: P=0.005; NIT: P=0.02; ENA: P=0.007) and glomerular hyperfiltration conditions (AML: P=0.0003; NIT: P=0.03; ENA: P=0.00006). In baseline conditions, only ENA resulted in a significant drop in the GFR (P=0.008), while NIF, NIT and AML induced a significant increase (P=0.003, 0.03, 0.0001, respectively). However, in hyperfiltration conditions, NIT (0.08) and AML (0.00003) caused a decrease in the GFR, as did ENA (0.0003) but not NIF. In all the experimental conditions, a RVR reduction and an ERPF increase were observed. Single dose of NIT and AML were effective in attenuating the effect of amino-acid infusion on glomerular filtration, similar to ENA; this effect of NIT and AML on the glomerular filtration rate is not observed under basal conditions.