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REPLY
Smoking and Abnormalities in Renal Function
Sara-Joan Pinto-Sietsma, MD;
Wilbert M.T. Janssen, MD, PhD; and
Paul E. de Jong, MD, PhD
3 July 2001 | Volume 135 Issue 1 | Page 68
IN RESPONSE:
We appreciate the interest in our recent article on smoking and renal abnormalities in nondiabetic persons. As Drs. Mehler and Estacio point out, smoking has been found to have adverse effects on renal function not only in patients with type 1 diabetes mellitus but also in those with type 2 diabetes mellitus (1). We agree with their plea that physicians should strongly encourage cessation of smoking in patients with type 2 diabetes mellitus. Our finding that smoking is also associated with both albuminuria and renal function changes in patients without diabetes argues that smoking has renal effects independent of the diabetic setting. It adds to our knowledge about the mechanism of albuminuria. Increased urinary albumin excretion seems to be a phenomenon related not only to diabetes and hypertension but also to smoking, central obesity (Pinto-Sietsma SJ, Navis G, Janssen WM, de Zeeuw D, Gans RO, de Jong PE. A central body fat distribution is related to renal abnormalities. Unpublished data), and the use of oral contraceptives and hormone replacement therapy (2). This may partly explain why microalbuminuria may also be found in 5% to 6% of nondiabetic and nonhypertensive persons.
We thank Dr. Jay for drawing attention to the medical literature as early as 1922. At that time, it indeed was already reported that smoking could cause Bright disease, known in those days as congestion, degeneration, and damage of the kidney. Furthermore, it was described that tobacco induced a pronounced contraction of the vessels of the kidney (3). These and other historical data, as pointed out by Dr. Jay, underline the importance and difficulties of the struggle for smoking cessation. Microalbuminuria is thought to be an early marker for worsened renal and cardiovascular prognosis. Therefore, our finding that patients who stopped smoking no longer had an increased risk for microalbuminuria argues for a more aggressive and intensive approach to encourage smoking cessation in patients with microalbuminuria, both those with diabetes and those without.
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Author and Article Information
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University Hospital Groningen; 9713 GZ Groningen, the Netherlands (Pinto-Sietsma, Janssen, de Jong)
1. Mehler P, Jeffers B, Biggerstaff S, Schrier R. Smoking as a risk factor for nephropathy in non-insulin-dependent diabetics J Gen Intern Med. 1998;13:842-5. [PMID: 9844083].
2. Monster TBM, Janssen WMT, de Jong PE, de Jong-den Berg LTW. Oral contraceptives and hormone replacement therapy are associated with microalbuminuria. Arch Intern Med. [In press].
3. Kellogg JH. Tobaccoism. Battle Creek, MI: Modern Medicine Publishing; 1922.
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Articles
Smoking Is Related to Albuminuria and Abnormal Renal Function in Nondiabetic Persons
Sara-Joan Pinto-Sietsma, Jaap Mulder, Wilbert M.T. Janssen, Hans L. Hillege, Dick de Zeeuw, AND Paul E. de Jong
- Annals 2000 133: 585-591.
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