Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy

Sawicki, Peter T.; Mühlhauser, Ingrid; Bender, R.; Pethke, W.; Heinemann, Lutz; Berger, Michael

doi:10.1046/j.1365-2796.1996.468809000.x

Cited by 32 publications

(18 citation statements)

References 11 publications

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“…In Type I diabetes it has been shown to independently increase the degree of nephropathy [15]. In our study half of the participants smoked an average of 20 cigarettes a day.…”

Section: Discussionmentioning

confidence: 51%

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Kidney function and glomerulopathy over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria

et al. 2002

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Since the term microalbuminuria was coined and was shown to predict clinical nephropathy in Type-I (insulin-dependent) diabetes mellitus in the early 1980 s [1±3], the research has focused on the putative risk factors in the early stages of nephropathy and their relative importance for the decline in renal function. The present knowledge of these factors and the development of the ultrastructural changes in the glomeruli, i. e. basement membrane thickening and mesangial expansion, are scarce and primarily based on cross-sectional studies [4±8]. Long-term studies on homogeneous groups of Type I diabetic patients have not been carried out.Hyperglycaemia has been shown to be associated with the degree of glomerulopathy in incipient nephr- Diabetologia (2002) Abstract Aims/hypothesis. We aimed to investigate prospectively the interrelation between kidney function and glomerular morphological changes over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria. Methods. Kidney biopsies were taken at baseline and after 8 years in 18 subjects who were 20 years of age (19±29 mean and range), had duration of diabetes for 11 years (7±18), and who had an albumin excretion rate of 45 mg/min (15±194). The glomerular ultrastructural parameters were analysed using stereological methods. Results. At the end of the study three patients had an increased albumin excretion rate of more than 25 % a year, two of whom developed overt nephropathy. Glomerular filtration rate declined 2.3 ml/min´1.73 m ±2´y r ±1 . Glomerular volume, volume fractions of matrix and mesangium, and basement membrane thickness showed an increase over the 8 years. Multiple regression analysis showed that mean 8-years HbA 1 c , matrix volume fraction baseline and basement membrane thickness BMT baseline accounted for 70 % of the variation in AER at the end of the study. Mesangial volume fraction baseline, glomerular filtration fraction baseline, and mean 8-year HbA 1 c accounted for 73 % of the change in glomerular filtration rate from baseline. Smoking was strongly associated with the glomerular filtration rate at baseline (r = 0.65). When glomerular filtration rate baseline was omitted from the equation, smoking was the only significant parameter linked to the change in glomerular filtration rate from the baseline. Conclusion/interpretation. In patients who had diabetes for 20 years, long-term hyperglycaemia and glomerulopathy found 8 years prior to the study, and possibly smoking, affected renal function (i. e. albumin excretion rate and glomerular filtration rate). [Diabetologia (2002) 45: 253±261]

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“…In Type I diabetes it has been shown to independently increase the degree of nephropathy [15]. In our study half of the participants smoked an average of 20 cigarettes a day.…”

Section: Discussionmentioning

confidence: 51%

“…Several additional factors like glomerular hyperfiltration [13], high blood pressure [14], smoking [15] and genetic predisposition [16±17] are probably coplayers in the development of diabetic nephropathy but their role in the more short-term development of the specific glomerulopathy is not clear.…”

Section: : 253±261]mentioning

confidence: 99%

Kidney function and glomerulopathy over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria

et al. 2002

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“…This was also found in some previous cross-sectional or prospective studies (24,25), but not in all studies (9,18). It has been suggested that smoking induces acute increases in blood pressure (26,27) and increases vascular permeability in nondiabetic subjects, but this was not confirmed in other studies (27).…”

Section: Albumin Progression Ratementioning

confidence: 67%

Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients

2002

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OBJECTIVE -To evaluate prospectively putative risk factors for development of microalbuminuria and macroalbuminuria in type 1 diabetes.RESEARCH DESIGN AND METHODS -Prospective observational study of a cohort of type 1 diabetic patients followed in the outpatient clinic at Steno Diabetes Center for Յ10 years (median 9 years). We followed 537 patients aged Ն18 years with type 1 diabetes, with duration of diabetes Ն5 years, with normoalbuminuria (urinary albumin excretion rate Յ30 mg/24 h), and who were not taking antihypertensive medication. Risk factors for development of microalbuminuria and macroalbuminuria were evaluated.RESULTS -The mean progression of urinary albumin excretion rate was 7.6% (SE 0.8) per year. During follow-up, 134 patients (25%) progressed to persistent microalbuminuria or macroalbuminuria (Ͼ30 mg/24 h in two of three consecutive urine samples). Cox multiple regression analysis using baseline values of putative predictors of progression showed the following significant predictors of progression from normoalbuminuria to microalbuminuria or macroalbuminuria: baseline log urinary albumin excretion rate 2.63 (relative risk; 95% CI 1.65-4.19), HbA 1c 1.13% (1.04 -1.23), presence of any retinopathy 1.90 (1.26 -2.88), and smoking 1.61 (1.11-2.33). Sex, duration of diabetes, arterial blood pressure, serum creatinine, height, and social class were not risk factors.CONCLUSIONS -Our study suggests that several potentially modifiable risk factors predict the development of microalbuminuria and macroalbuminuria in type 1 diabetic patients. Diabetes Care 25:859 -864, 2002

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“…In patients with diabetes mellitus, presence or absence of autonomic neuropathy is a major determinant of the effects of smoking on BP. For instance, among patients with type 1 diabetes, smoking increased systolic BP only in subjects without autonomic neuropathy (80).…”

Section: Potential Mechanisms Of Smoking-induced Renal Damagementioning

confidence: 99%

Smoking and the Kidney

Orth¹

2002

Journal of the American Society of Nephrology

148

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Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy

Abstract: Smoking increases blood pressure values in healthy subjects and in hypertensive patients with diabetic nephropathy and without autonomic neuropathy. This effect of smoking may be partly responsible for the faster progression of diabetic nephropathy in smoking diabetic patients.

Cited by 32 publications

References 11 publications

Kidney function and glomerulopathy over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria

Kidney function and glomerulopathy over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria

Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients

Smoking and the Kidney

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