What is the best approach for a patient with worsening renal insufficiency and intolerance of ACE inhibitors or angiotensin receptor blockers (ARBs)?
—Ann Marchetta, MS, ARNP-C, FNP, Waupaca, Wis.

Calcium channel blockers (CCBs) are considered next in line for these patients. CCBs (specifically the nondihydropyridines) also have some angiotensin II-blocking activity. The degree of proteinuria determines how long this therapy is safe. Patients whose proteinuria progresses should be referred to a nephrologist or internist for further management.
—Sherril Sego, MSN, FNP (115-1)

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