Smoking: A factor promoting onset and progression of diabetic nephropathy

Although smoking was identified two decades ago as a factor promoting the o nset and progression of nephropathy in Type 1 and then in Type 2 diabetes, its role has been largely neglected. More recently, it has been shown that smoking adversely affects renal haemodynamics and protein excretion even in subjects without renal disease. In addition, it impairs the prognosis for renal function in patients with nondiabetic renal disease. Recent studies h ave suggested the involvement of sympathetic activation, increased endothel in production, and impaired endothelial cell-dependent vasodilatation in th e genesis of smoking-induced renal function impairement. Cessation of smoki ng apparently slows progression to renal failure, but the decision to stop smoking is difficult because of the high addictive potential of the habit. The challenge remains for diabetologists and nephrologists to motivate pati ents to stop smoking.