What is the role of calcium channel blockers in the management of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Non-dihydropyridine calcium channel blockers (NDCCBs), diltiazem and verapamil, have been shown to decrease proteinuria greater than dihydropyridine calcium channel blockers (DCCBs). The difference between the two is thought to stem from the fact that DCCBs affect only the afferent arteriole and not the efferent, whereas NDCCBs affect both. The effect of action on the afferent arteriole only is impaired autoregulation and increased intraglomerular pressure, leading to kidney damage.

L type calcium channels are found only in the proximal tuble and are the primary channel affected by DCCBs. However, N and T type calcium channes are found in both the afferent and efferent arteriole; the newer NDCCBs such as efonidipine and benedipine work on these channels. The newer NDCCBs, used in combination with ARBs, have been shown to reduce proteinuria. [44, 45]


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