The renal risks of smoking: an update

Smoking increases the renal risk both in diabetic and in nondiabetic renal disease. The purpose of the present review is to summarize the current state of knowledge about this important remediable renal risk factor.

The deleterious effect of smoking on renal function extends beyond patients with primary or secondary renal disease and patients with a renal transplant, because recent studies document a relation between smoking and loss of filtration rate, even in cardiovascular high-risk populations without primary renal disease such as the elderly, the patient with severe essential hypertension, or the patient with widespread atherosclerosis. Furthermore, recent studies show that in nondiabetic patients without primary renal disease, albuminuria, a potential surrogate marker of glomerular damage, is correlated with smoking. The mechanisms underlying the adverse renal effects of smoking are still incompletely understood. Beyond its effect on progression of renal failure, smoking is also an important cardiovascular risk factor in the patient with renal failure or the patient with a renal transplant.

Smoking is one of the most important remediable renal risk factors. The exact mechanisms of smoking-induced renal damage remain to be determined. For all the above reasons cessation of smoking should be recommended to renal patients - a recommendation which is infrequently given and even less frequently followed.