Chronic Glomerulonephritis Medication

Updated: Feb 01, 2017
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print
Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications used to treat chronic glomerulonephritis include angiotensin-converting enzyme (ACE) inhibitors (ACEIs), diuretics, calcium channel blockers, beta-adrenergic blockers, and alpha-adrenergic agonists.

Next:

ACE Inhibitors

Class Summary

ACEIs are renoprotective agents. They decrease intraglomerular pressure and, consequently, glomerular protein filtration by decreasing efferent arteriolar constriction.

Enalapril (Vasotec)

Enalapril is a competitive inhibitor of ACE. It reduces angiotensin II levels, thus decreasing aldosterone secretion. It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction.

Captopril

Captopril prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. It is rapidly absorbed, but bioavailability is significantly reduced with food intake. Captopril achieves a peak concentration in 1 hour and has a short half-life. It is cleared by the kidney; impaired renal function requires reduction of the dosage. The drug is absorbed well orally.

It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction. Give captopril at least 1 hour before meals. If it is added to water, use it within 15 minutes. The dose can be low initially, then titrated upward as needed and as tolerated by the patient.

Lisinopril (Prinivil, Zestril)

Lisinopril prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion. It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction.

Benazepril (Lotensin)

Benazepril prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion.

It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction.

Fosinopril

Fosinopril is a competitive ACE inhibitor. It prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion. It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction.

Quinapril (Accupril)

Quinapril is a competitive ACE inhibitor. It reduces angiotensin II levels, decreasing aldosterone secretion. It decreases intraglomerular pressure and glomerular protein filtration by decreasing efferent arteriolar constriction.

Previous
Next:

Diuretics, Loop

Class Summary

Diuretics are used to treat edema and hypertension. They increase urine excretion by inhibiting sodium and chloride transporters.

Furosemide (Lasix)

Furosemide is the diuretic of choice. It increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and the distal renal tubule.

Bumetanide (Bumex)

Bumetanide increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium, potassium, and chloride reabsorption in the ascending loop of Henle. These effects increase the urinary excretion of sodium, chloride, and water, resulting in profound diuresis. Renal vasodilation occurs after administration, renal vascular resistance decreases, and renal blood flow is enhanced. In terms of effect, 1 mg of bumetanide is equivalent to approximately 40 mg of furosemide.

Ethacrynic acid (Edecrin)

Ethacrynic acid increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. This agent is used only in refractory cases. Continuous IV infusion is preferable in many cases. It is indicated for temporary treatment of edema associated with heart failure when greater diuretic potential is needed.

Previous
Next:

Diuretics, Thiazide

Class Summary

Diuretics are used to treat edema and hypertension. They increase urine excretion by inhibiting sodium and chloride transporters.

Metolazone (Zaroxolyn)

Metolazone treats edema in congestive heart failure. It increases excretion of sodium, water, potassium, and hydrogen ions by inhibiting reabsorption of sodium in distal tubules. It may be more effective in cases of impaired renal function.

Hydrochlorothiazide (Microzide)

Hydrochlorothiazide inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as potassium and hydrogen ions.

Previous
Next:

Calcium Channel Blockers

Class Summary

Calcium channel blockers are used to treat hypertension, angina, and atrial fibrillation.

Amlodipine (Norvasc)

Amlodipine blocks slow calcium channels, causing relaxation of vascular smooth muscles.

Nifedipine (Procardia)

Nifedipine relaxes coronary smooth muscle and produces coronary vasodilation, which, in turn, improves myocardial oxygen delivery. Sublingual administration is generally safe, theoretical concerns notwithstanding.

Felodipine

Felodipine relaxes coronary smooth muscle and produces coronary vasodilation, which, in turn, improves myocardial oxygen delivery. It benefits nonpregnant patients with systolic dysfunction, hypertension, or arrhythmias. It can be used during pregnancy if clinically indicated.

Calcium-channel blockers potentiate ACE inhibitor effects. Renal protection is not proven, but these agents reduce morbidity and mortality rates in congestive heart failure. Calcium channel blockers are indicated in patients with diastolic dysfunction. They are effective as monotherapy in black patients and elderly patients.

Isradipine (DynaCirc)

Isradipine is a dihydropyridine calcium channel blocker. It inhibits calcium from entering select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization. This causes relaxation of coronary vascular smooth muscle, which results in coronary vasodilation. Vasodilation reduces systemic resistance and blood pressure, with a small increase in resting heart rate. Isradipine also has negative inotropic effects.

Verapamil (Calan, Isoptin, Verelan)

During depolarization, verapamil inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium. It can diminish premature ventricular contractions (PVCs) associated with perfusion therapy and decrease risk of ventricular fibrillation and ventricular tachycardia. By interrupting re-entry at the AV node, it can restore normal sinus rhythm (NSR) in patients with paroxysmal supraventricular tachycardias.

Diltiazem (Cardizem, Dilacor XR, Diltzac, Matzim LA)

During depolarization, diltiazem inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Previous
Next:

Beta-Blockers, Beta-1 Selective

Class Summary

Beta-adrenergic blockers compete with beta-adrenergic agonists for available beta-receptor sites. These agents inhibit mainly beta1 receptors (located mainly in cardiac muscle).

Metoprolol (Lopressor, Toprol XL)

Metoprolol is a selective beta1-adrenergic blocker that decreases the automaticity of contractions. During intravenous (IV) administration, carefully monitor blood pressure, heart rate, and electrocardiographic readings.

Bisoprolol (Zebeta)

Bisoprolol is a selective beta1-adrenergic receptor blocker that decreases automaticity of contractions.

Esmolol (Brevibloc)

Esmolol is an ultra–short-acting beta2-blocker. It is particularly useful in patients with labile arterial pressure, especially if surgery is planned, because it can be discontinued abruptly if necessary. It may be useful as a means to test beta-blocker safety and tolerance in patients with a history of obstructive pulmonary disease who are at possible risk of bronchospasm from beta-blockade. The elimination half-life of esmolol is 9 minutes.

Atenolol (Tenormin)

Atenolol selectively blocks beta-1 receptors with little or no effect on beta-2 receptors.

Previous
Next:

Beta-Blockers, Nonselective

Class Summary

Nonselective beta-blockers inhibit both beta1 receptors (located mainly in cardiac muscle) and beta2 receptors located in the bronchial and vascular musculature. These agents slow the sinus rate and decrease AV nodal conduction. Carefully monitor blood pressure.

Propranolol (Inderal LA, InnoPran XL)

Propranolol is a class II antiarrhythmic nonselective beta-adrenergic receptor blocker. It has membrane-stabilizing activity and decreases the automaticity of contractions.

Sotalol (Betapace, Sorine)

This class III antiarrhythmic agent blocks K+ channels, prolongs action potential duration (APD), and lengthens the QT interval. It is a non–cardiac selective beta-adrenergic blocker. Sotalol is shown to be effective in the maintenance of sinus rhythm, even in patients with underlying structural heart disease.

Labetalol (Trandate)

Labetalol blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure.

Penbutolol

Pindolol has mild intrinsic sympathomimetic activity and negative chronotropic and inotropic effects.

Penbutolol (Levatol)

Penbutolol has mild intrinsic sympathomimetic activity and negative chronotropic and inotropic effects.

Previous
Next:

Alpha-Blockers, Antihypertensives

Class Summary

Alpha1 antagonists may be used to achieve the target pressure. Peripheral alpha-antagonists inhibit postsynaptic alpha-adrenergic receptors, resulting in vasodilation of veins and arterioles and decreasing total peripheral resistance and blood pressure. These drugs often cause marked hypotension after the first dose. High doses are likely to cause postural hypotension. Of the peripheral alpha-antagonists, doxazosin and terazosin are selective for alpha1 -receptors. Prazosin is nonselective and inhibits both alpha1- and alpha2-receptors.

Doxazosin (Cardura, Cardura XL)

Doxazosin, a quinazoline compound, is a selective alpha1-adrenergic antagonist. It inhibits postsynaptic alpha-adrenergic receptors, causing vasodilation of veins and arterioles and decreases total peripheral resistance and blood pressure.

Prazosin (Minipress)

Prazosin treats prostatic hypertrophy. It improves urine flow rates through relaxation of smooth muscle, accomplished by blocking alpha1-adrenoceptors in the bladder neck and prostate. When increasing the dose, administer the first dose of each increment at bedtime to reduce syncopal episodes. Although doses higher than 20 mg/day usually do not increase efficacy, some patients may benefit from doses as high as 40 mg/day.

Terazosin

Terazosin decreases arterial tone by allowing peripheral postsynaptic blockade. It has minimal alpha2 effect.

Previous
Next:

Vasodilators

Class Summary

These drugs act directly on the smooth muscle in the peripheral vasculature to cause vasodilation. Tachycardia and fluid retention are common adverse effects. Prolonged use of minoxidil can cause hypertrichosis. Hydralazine can cause a lupuslike syndrome in certain populations of slow acetylators. Examples of direct vasodilators are minoxidil and hydralazine. Vasodilators may be used to achieve the target pressure.

Minoxidil

Minoxidil relaxes arteriolar smooth muscle, causing vasodilation, which, in turn, may reduce blood pressure.

Hydralazine

Hydralazine decreases systemic resistance through direct vasodilation of arterioles. It is used to treat hypertensive emergencies. The use of a vasodilator reduces systemic vascular resistance, which, in turn, may allow forward flow, improving cardiac output.

Nitroprusside sodium (Nitropress)

Nitroprusside sodium produces vasodilation and increases inotropic activity of the heart. At higher dosages, it may exacerbate myocardial ischemia by increasing the heart rate.

Nitroglycerin (Nitro-Bid, Nitrostat, Nitro-Dur, Nitrolingual, NitroMist)

Nitroglycerin is primarily a venodilator that decreases both preload and afterload.

Previous
Next:

Alpha2 Agonists, Central-Acting

Class Summary

Alpha-adrenergic agonists are used in combination with other agents for management of hypertension.

Clonidine (Catapres, Duraclon, Nexiclon XR)

Clonidine stimulates presynaptic (central) alpha2-adrenergic receptors, thereby reducing norepinephrine release and peripheral vasoconstriction.

Previous