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Smoking and Abnormalities in Renal Function
- Sara-Joan Pinto-Sietsma, MD;
- Wilbert M.T. Janssen, MD, PhD; and
- Paul E. de Jong, MD, PhD
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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 Unpublished data), and the use of oral contraceptives and hormone replacement therapy (2).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.
Sara-Joan Pinto-Sietsma, MD
Wilbert M.T. Janssen, MD, PhD
Paul E. de Jong, MD, PhD
University Hospital Groningen; 9713 GZ Groningen, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
