Potential role of cigarette smoking in two emerging endemic diseases: Chronic kidney disease and diabetes mellitus

Richard Halmai, István Wittmann

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The fight against cigarette smoking is a global challenge. Smoke is harmful in both active and passive smokers and it has a role in the initiation and progression of certain chronic kidney diseases (CKD), in the initiation of type 2 diabetes mellitus and in the development and progression of diabetic nephropathy and cardiovascular complications of diabetes mellitus (DM). Chronic kidney failure per se raises the risk of cardiovascular morbidity and mortality. Therefore tobacco use can be considered as a starter and/or confounder process that diminishes life quality or even shortens life expectancy. Cigarette smoking is a risk factor for chronic kidney disease and a predictor for the risk of end-stage kidney failure in the general population both in women and men. Smoking is the most significant factor associated with albuminuria in hypertensive patients, moreover, GFR-decline is generally faster in smokers versus non-smokers. Cigarette consumption seems to have a cumulative effect in the development of atherosclerotic renal artery stenosis. In IgA nephropathy, which is the most frequent primary glomerulonephritis, smoking habit is clearly related to worse disease progression. The role of tobacco in the course of autosomal dominant polycystic kidney disease is yet controversial. However, in lupus nephritis smoking is associated both with faster progression and poorer outcomes after transplantation. Smokers on renal replacement therapy have generally a higher risk for mortality. The pathomechanism is probably multi-causative and somewhat different in the specific kidney diseases, but common "steps" are also present as shown in histology results. Smoking causes insulin resistance - thus increases the risk of developing metabolic syndrome and type 2 diabetes. Both in type 1 and type 2 diabetes, smoking increases the risk of development and progression of nephropathy and nearly doubles the rate of progression to end-stage renal failure. Cigarette smoking causes not only a deterioration in renal function, but also elevates microalbuminuria and proteinuria in diabetes mellitus. The pathomechanism of diabetic nephropathy is also complex, the rise in the urinary podocyte excretion is probably an early sign. In the future, having tools for the detection of the smoking-induced damage by biomarkers or ultrasound of the kidney would be a great help in the understanding of the pathomechanism. Chronic kidney diseases and diabetes mellitus should be prevented, therefore the intervention in the smoking habit - as a modifiable risk factor - should begin very early!

Original languageEnglish
Title of host publicationCigarette Consumption and Health Effects
PublisherNova Science Publishers, Inc.
Pages123-153
Number of pages31
ISBN (Print)9781620817254
Publication statusPublished - Jan 1 2013

ASJC Scopus subject areas

  • Medicine(all)

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    Halmai, R., & Wittmann, I. (2013). Potential role of cigarette smoking in two emerging endemic diseases: Chronic kidney disease and diabetes mellitus. In Cigarette Consumption and Health Effects (pp. 123-153). Nova Science Publishers, Inc..