Effects of Cigarette Smoking on Glomerular Structure and Function in Type 2 Diabetic Patients

Baggio, Bruno; Budakovic, Alessandro; Vestra, Michele Dalla; Saller, Alois; Bruseghin, Marino; Fioretto, Paola

doi:10.1097/01.asn.0000032422.81130.68

Cited by 59 publications

(54 citation statements)

References 42 publications

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“…The negative finding concerning the severity of glomerulosclerosis of course does not exclude an effect of smoking on glomerular structure. An increase in glomerular basement membrane (GBM) width in patients who have type 2 diabetes and smoke has been reported in a recent biopsy study (55). GFR was negatively correlated with heavy current smoking.…”

Section: Pathohistological Findings In the Kidney Of Smokersmentioning

confidence: 76%

Effects of Smoking on Systemic and Intrarenal Hemodynamics

Orth¹

2004

Journal of the American Society of Nephrology

115

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Abstract. In recent years, it has become apparent that smoking has a negative impact on renal function, being one of the most important remediable renal risk factors. It has been shown clearly that the risk for high-normal urinary albumin excretion and microalbuminuria is increased in smoking compared with nonsmoking subjects of the general population. Data from the Multiple Risk Factor Intervention Trial indicate that at least in men, smoking increases the risk to reach end-stage renal failure. Smoking is particularly "nephrotoxic" in older subjects, subjects with essential hypertension, and patients with preexisting renal disease. Of interest, the magnitude of the adverse renal effect of smoking seems to be independent of the underlying renal disease. Death-censored renal graft survival is decreased in smokers, indicating that smoking also damages the renal transplant. Cessation of smoking has been shown to reduce the rate of progression of renal failure both in patients with renal disease and in patients with a renal transplant. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in BP and presumably intraglomerular pressure) and chronic effects (e.g., endothelial cell dysfunction). Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly, survival of smokers with diabetes on hemodialysis is abysmal.Smoking has profound effects on systemic and intrarenal hemodynamics. A smoking-induced increase in BP and heart rate had first been reported in 1907 by Hesse (1). Although others had even found an association between smoking and renal damage (2), this has only been confirmed in 1979 in patients with type 1 diabetes (3), and it was not until 1997 (4) that nephrologists became aware of smoking being a major renal risk factor.The effects of smoking on BP were a matter of debate in the 1980s. Large epidemiologic studies had found that smokers are not more frequently hypertensive than nonsmokers (5). These studies, however, did not perform ambulatory BP measurement, which besides that smokers weigh less than their more obese nonsmoking counterparts explains these false-negative results (6). More recent studies using ambulatory BP measurement clearly document that smokers have higher BP than nonsmokers, i.e. an increase of approximately 3 to 12 mmHg in mean arterial pressure (MAP). This has been shown in several studies including healthy subjects, hypertensive subjects, patients with type 1 and type 2 diabetes, and patients with primary renal disease (for review, see reference 7). With an increase of 12 mmHg in MAP, patients with renal disease seem to be particularly prone to the effect of smoking on BP. There is some evidence, at least in hypertensive patients, that elderly subjects (Ͼ50 to 60 yr of age) are more affected than younger subjects (8,9). A recent population-based cross-sectional study investigated 12,417 men who were screened for a routine check-up in France (9). The preval...

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Section: Pathohistological Findings In the Kidney Of Smokersmentioning

confidence: 76%

Effects of Smoking on Systemic and Intrarenal Hemodynamics

Orth¹

2004

Journal of the American Society of Nephrology

115

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“…The progression of glomerular structural damage (matrix and mesangial/glomerular volume fractions, basement membrane thickness) was more pronounced in smokers than in nonsmokers. Baggio et al (71) performed a renal biopsy study in 96 patients with type 2 diabetes and found that heavy smoking was associated with increased glomerular basement membrane thickness.…”

Section: Histopathologic Features Of Smoking-induced Renal Damagementioning

confidence: 99%

Smoking

Orth

Hallan²

2008

Clinical Journal of the American Society of Nephrology

254

174

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Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.

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“…Studies have shown that the primary defect in CFR patients occurs in cellular immunity, which is facilitated by T lymphocytes. 3,8,9 However, the number of studies that have investigated the effects of CRF and smoking on the immune system together is limited.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to humoral and cellular immune system defects, the primary issue with CRF is regarding intracellular immunity, in which T-lymphocytes play a role. 7,8 Graft survival is affected negatively in kidney transplant patients who smoke. 9 However, there is not enough data about the extent of damage to the immune system caused by smoking in patients with CRF.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: Smoking is known to suppress the immune system. It is also known that chronic renal failure affects the immune system. However, the number of studies investigating the effects of chronic renal failure and smoking together is limited. In our study, we examined whether smoking affects the diminished response of the immune system in patients with chronic renal failure. Materials and Methods: We compared peripheral blood lymphocyte subsets in smoking and nonsmoking patients with chronic renal failure. We also used the Fagerström Test for Nicotine Dependence to evaluate its correlation with the lymphocyte subset count in patients who are current smokers. Results: Our study included 126 patients with chronic renal failure. According to their smoking habits, patients were divided into 2 groups: smokers and nonsmokers. The average age of patients who were smokers was 53.2 ± 1.5 years, with average age of nonsmokers being 59.2 ± 2.2 years. The average duration of smoking in smokers was 30.7 ± 2.7 packyears. We found that the percentage of cluster of differentiation 16-56 cells (natural killer cells) and lymphocyte percentage were significantly lower among smokers in our study (P < .05). We compared the lymphocyte subset panel to pack-years and found that the rate of cluster of differentiation 16-56 cells decreased as smoking duration increased. Conclusions: Our study revealed that smoking suppresses the immune system, as measured by lymphocyte subsets, in patients with chronic renal failure, similar to that shown in healthy smokers. According to our findings, patients with chronic renal failure, where infection is the primary reason for mortality and morbidity, must be questioned for smoking and referred to smoking cessation clinics. Because of its immunosuppressive effects, smoking behaviors must be solved preoperatively in transplant candidates.

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Effects of Cigarette Smoking on Glomerular Structure and Function in Type 2 Diabetic Patients

Cited by 59 publications

References 42 publications

Effects of Smoking on Systemic and Intrarenal Hemodynamics

Effects of Smoking on Systemic and Intrarenal Hemodynamics

Smoking

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