Nicotine and the kidney: Mr. Hyde, and perhaps some Dr. Jekyll

Abstract

LITERATURE REGARDING THE EFFECTS of smoking on the kidney is rather abundant. However, data assessing the singular effects of nicotine on the kidney are sparse. There are more than 100 substances in tobacco, and nicotine is not a direct cause of most of the tobacco-related diseases (2). Nicotine is, however, highly addictive and as such is, in large part, responsible for the ill effects of smoking. This commentary will focus only on the effects of nicotine on the kidney.Nicotine administered intravenously (iv) at 2 g/kg/min over 10 min results in the exposure equivalent of smoking one cigarette and will result in a nicotine plasma level of 15-20 ng/ml. These and other data suggest a volume of distribution for nicotine equal to or greater than total body water. Although nicotine is absorbed with high efficiency across oral and respiratory membranes, the bioavailability of orally administered nicotine is only 20 -45% (11).One of the earliest reported and still best characterized actions of nicotine is the direct stimulation of release of antidiuretic hormone (ADH), resulting in increased urinary osmolality and decreased free water clearance (3).Studies of the hemodynamic effects of nicotine on kidney function reveal a more complex picture. Early experiments in dogs demonstrated that either iv (1-3 mg) or intrarenal arterial infusion (0.5 g·min Ϫ1 ·kg Ϫ1 over 15 min) of nicotine increased the glomerular filtration rate (GFR), urine volume, and sodium excretion without having a significant effect on fractional excretion of sodium, renal blood flow (RBF), or systemic arterial blood pressure (BP). These effects were attributed to nicotine-induced catecholamine release (3,20

Activation of the Cholinergic Anti-Inflammatory Pathway as a Novel Therapeutic Strategy for COVID-19

“…The detrimental effect of nicotine in different organ systems are debatable. For example, the harmful effects of smoking on the kidney is rather abundant, but the data assessing the singular effects of nicotine on the kidney are sparse ( 50 ). Conversely, nicotine is reported to protect kidney from renal ischemia/reperfusion injury through the CAP ( 51 ).…”