Hypertension-associated nephropathy is mediated by nephrosclerosis and as smoking damages arterioles, progressive vascular injury is the likely mechanism for the progressive renal decline attributable to smoking. Based on observations in general populations, it is reasonable to expect that stopping smoking will improve chronic renal disease outcomes, but there is not enough long term evidence regarding renal function in renal diseases. Therefore, it is a potentially modifiable risk factor for both diabetic nephropathy and cardiovascular disease, but we still do not know whether stopping smoking delays the progression of diabetic kidney disease. However there is enough circumstantial evidence for physicians to advise patients with diabetes in general and diabetic kidney disease in particular to stop smoking and to alert patients to the increased risk that they face by continuing to smoke. Efforts to reduce the prevalence of smoking amongst patients with diabetes to a level below that in the general population should be a prime target of diabetes management.
Cigarette smoking is an adverse prognostic factor in non-diabetic nephropathies.
For women, the percentage of smokers did not differ between cases with and without chronic renal failure, but the sample was too small to allow conclusion. Cigarette smoking, hydrocarbon solvents and other inhaled toxins affect the rate of lung hemorrhage in antiglomerular basement membrane disease. The most plausible explanation is that smoking increases lung capillary permeability and thus enables antibodies to reach the alveolar basement membrane. The mechanisms by which chronic cigarette smoking causes arterial damage have not been defined. However, functional and morphologic endothelial changes seem to play an important role.