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Cigarette Smoke Inhalation Aggravates Diabetic Kidney Injury: An Overview

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Cigarette smoking is one of the major causes of diabetic kidney diseases leading to a high risk of developing diabetic kidney injury.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Manzoor Ahmad Parry

Published At October 13, 2022
Reviewed AtMarch 10, 2023


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.


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.

Frequently Asked Questions


Can Smoking Lead to Kidney Failure?

Numerous techniques, including smoking, can gravely injure the kidneys. It may raise the risk of getting some types of kidney cancer. Damage to the cardiovascular system (heart and blood arteries) results in poor blood flow to the kidneys, resulting in kidney disease over time.


Can Kidneys Heal After Quitting Smoking?

Not only can quitting smoking lower the likelihood of contracting additional ailments, but it can also hasten a patient's recovery by removing smoking's immediate adverse effects on the body. For example, it may aid those with type two diabetes and renal disease in slowing the loss of kidney function.


How Long Does It Take To Reverse Damage Caused by Smoking?

The function gets better between two and three weeks following the last smoke. Coughing and shortness of breath lessen the first year after quitting, and your lungs get better at cleaning themselves to lower the risk of infection.


What Test Is Done to Evaluate Diabetic Kidney Disease?

Medical practitioners use blood and urine tests to look for diabetic kidney damage. To determine how well the kidneys filter blood, the doctor will check urine for albumin and perform a blood test. To test for kidney illness, medical experts utilize blood and urine tests.


What Tests Are Used to Check for Kidney Disease?

Tests used such as urine dipstick test, urine albumin-to-creatinine ratio (UACR), serum creatinine, glomerular filtration rate (GFR), blood urea nitrogen (BUN), blood pressure, and imaging.


Is Creatinine Related to Diabetes?

Creatinine builds up in your circulation due to diabetes, which can harm the filtration system and impair the capacity to remove waste from your blood. The most common cause of kidney failure is a renal disease in individuals with diabetes.


What Area of the Kidney Is Damaged by Diabetes?

Diabetes-related elevated blood sugar over time can harm kidney blood vessels and nephrons, impairing their ability to function as they should. In addition, high blood pressure is a common complication of diabetes and can also harm the kidneys.


Is Kidney Damage From Diabetes Reversible?

After the onset of diabetes, kidney damage may develop after 10 to 15 years. The kidneys ability to purge the blood decreases as the damage increases. The kidneys may stop functioning if the damage becomes severe enough. Damage to the kidneys cannot be undone.


What Are the Signs Associated With Kidney Problems?

Nausea, vomiting, and appetite loss are symptoms. Patients may also show feeble and weary, sleep issues, less urinating, muscle cramping, and a decline in mental clarity.


What Is the Treatment of Kidney Damage From Diabetes?

Renal dialysis is the procedure that clears blood of waste materials and surplus fluid.
A transplant is a better option in some circumstances; a kidney or a kidney-pancreas transplant may be the best option. In some cases, symptom control is preferred.


How Can I Protect My Kidneys From Diabetes?

Make nutritious meal selections. Include exercise in the daily regimen. Aim to maintain a healthy weight. Get adequate rest. Stop using tobacco. Limit alcohol consumption. Look into stress-relieving activities. Control heart disease, diabetes, and high blood pressure.


How to Diagnose Diabetic Nephropathy?

To diagnose the kidneys, the doctor could use ultrasound and X-rays. Magnetic resonance imaging or a computed tomography scan is done to determine how well the blood flows through your kidneys. In some circumstances, different imaging tests might be used. In some cases, renal biopsy will be helpful.


What Is a Serious Creatinine Level?

Age and physical size can affect the blood level of creatinine. An early indication that the kidneys are not functioning properly may be a creatinine level higher than 1.2 for women and more significant than 1.4 for men. In addition, creatinine levels in the blood rise as the renal disease worsen.


When Is Dialysis Required?

The patient often requires dialysis when the creatinine clearance drops to 10 to 12 cc per minute. If the patient is experiencing an inability to rid the body’s excess water, there are problems in the heart, lungs, and stomach, difficulties in taste, and sensation in the legs, then also dialysis is performed even if the creatinine clearance has not dropped to 10 to 12 cc per minute.
Dr. Manzoor Ahmad Parry
Dr. Manzoor Ahmad Parry



diabetic nephropathy
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