Cigarette Smoke Inhalation Aggravates Diabetic Kidney Injury: An Overview

Introduction

Smoking cigarettes can increase the risk of developing Type-2 diabetes mellitus, leading to various health issues like kidney diseases and heart diseases. If someone has diabetes and smokes a cigarette, it can aggravate the condition and cause damage to the kidneys by increasing the serum creatinine levels in the body. Quitting smoke can help improve diabetic conditions and minimize kidney disease risk.

What Is Diabetic Kidney Injury?

Diabetic kidney disease (diabetic nephropathy) is the type of kidney disease associated with diabetes, causing a decrease in normal kidney functioning. This condition progresses over the years and leads to the inability of kidney filters (glomeruli) to filter the waste inside the body, causing various health issues and decreasing urine output.

How Does Smoking Cause Damage to Kidneys?

Studies show that smoking can cause damage to kidneys or kidney injury in many ways, such as hyperlipidemia, causes the accumulation of glycation end-products, and activates the renin-angiotensin system. Also, smoking during an already existing diabetic condition can alter the kidneys’ pathology, like glomerular basement membrane thickness, interstitial fibrosis, and glomerulosclerosis, which later causes end-stage kidney failure or diabetic nephropathy.

What Are the Symptoms of Diabetic Kidney Injury?

• Weight loss.

• Poor appetite.

• Muscle cramps.

• Frequent urination.

• Puffiness around eyes.

• Anemia.

• Nausea and vomiting.

• Swollen feet, ankles, and hands due to fluid retention.

• Blood pressure fluctuations.

• Shortening of breath (SOB).

• Protein in urine.

• Difficulty in concentration.

• Fatigue.

What Are the Risk Factors Associated With Diabetic Kidney Injury?

• Anemia - It is caused due to decrease in the red blood cell count carrying oxygen.

• Diabetic Retinopathy - Light-sensitive tissues also get affected due to blood vessel damage at the back of the eye.

• Cardiovascular disease - The risk of stroke increases due to heart and blood vessel damage and a diabetic condition.

• Hyperkalemia - Potassium levels in the body also rise.

• Pulmonary Edema - Swelling in legs, and arms, high blood pressure due to fluid retention in the body and lungs.

• End-stage Kidney Disease - It is the damage to the kidney and can only be treated with a kidney transplant or dialysis.

How Can We Diagnose Diabetic Kidney Injury?

Screening tests are done regularly:

• Albumin or Creatinine Ratio - This determines kidney functioning by estimating the amount of creatinine in urine compared to the levels in the body. Creatinine is the by-product filtered by the kidney from blood.

• Urinary Albumin Test - This test calculates blood protein albumin in the urine. Albumin is not filtered out of the body, so this test determines the protein in the urine.

• Glomerular Filtration Test (GFR) - This screening method usually measures the creatinine filtration rate of kidneys.

• Kidney Biopsy - In this method, a small part of kidney tissue is removed under local anesthesia with the help of a thin needle to study under a microscope.

• Imaging Tests - Diagnostic tests like x-rays, ultrasound, MRI(magnetic resonance imaging), and CT(computed tomography) scans can be done to examine the kidney and its blood circulation.

How Can We Prevent Kidney Injury or Diabetic Nephropathy?

• Quit Smoking- Smoking can increase the risk of developing type 2 diabetes and can cause damage to the kidneys. In addition, the condition might worsen if smoking is not stopped in case of already existing kidney problems.

• Proper Weight Management- Increased body weight is another reason for developing diabetes; staying active can help in weight management.

• Regular Diabetes Management- Regular visits to the doctor must be followed strictly to keep diabetes in control. This can reduce the risk of developing kidney injury or even delay it.

• Instruction on Medication Must Be Followed- Painkillers can cause damage to the kidneys, especially in diabetic nephropathy conditions. So, aspirin and nonsteroidal anti-inflammatory drugs must be taken carefully following the packaging instructions.

What Are the Treatments for Diabetic Kidney Injury?

1. The first stage of diabetic nephropathy can be treated with the help of medication to manage blood sugar and hypertension:

• Blood Sugar Control- This can be managed with the help of medication like Metformin (Fortamet) which improves insulin sensitivity and decreases glucose production in the liver. Some medicines (Glucagon-like peptide one receptor agonists) can slow down digestion and lower the blood sugar in the body.

• Blood Pressure Control- ACE ( Angiotensin-Converting Enzyme) and ARBs (Angiotensin 2 Receptor Blockers) help to manage blood pressure.

• Cholesterol Control- Statins (cholesterol-controlling drugs) help to lower cholesterol levels in the body and decrease protein levels in urine.

• Kidney Scarring- Diabetic neuropathy can be treated with Finerenone (Kerendia). This drug helps reduce the risk factors of kidney failure, deaths due to cardiovascular dysfunction, and heart attacks.

2. The advanced stage of diabetic nephropathy (end-stage kidney failure) can be managed with the following options:

• Kidney Dialysis- This method helps to remove waste products from the blood when the kidneys stop functioning. Both can be done at a kidney care center or at home by a professional caregiver. Haemodialysis is the most common method in which patients have to visit the clinic three times a week to get their kidneys filtered with an artificial kidney machine.

• Transplant- The end-stage treatment can be done either with a kidney transplant or kidney-pancreas transplant, for which the eligibility for the surgery is determined and evaluated by the doctor.

• Symptom Management- If a person is unwilling to undergo any surgical options, the treatment is provided for comfort. Still, the life expectancy chances are reduced to a few months only.

Conclusion

Smoking not only causes damage to the lungs but also increases the risk factor for developing kidney diseases or kidney injury in diabetic conditions. Smoking reduces blood flow to vital organs and the effect of medication used to treat blood pressure. Therefore, quitting smoke can improve the kidney health associated with diabetes and prevent or delay kidney injury risk.