Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Clin J Am Soc Nephrol. 2011 Oct;6(10):2462-9. doi: 10.2215/CJN.00700111. Epub 2011 Sep 1.
Glomerular hyperfiltration and albuminuria accompanied by early-stage diabetic kidney disease predict future renal failure. Cigarette smoking has reported to be associated with elevated GFR in cross-sectional studies and with renal deterioration in longitudinal studies. The degree of glomerular hyperfiltration and proteinuria associated with smoking, which presumably is a phenomenon of early renal damage, has not been investigated in a satisfying manner so far.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study included 10,118 Japanese men aged 40 to 55 years without proteinuria or renal dysfunction at entry. Estimated GFR was calculated using the Modification of Diet in Renal Disease equation for Japanese. Glomerular hyperfiltration was defined as estimated GFR ≥117.0 ml/min per 1.73 m(2), which was the upper 2.5th percentile value of estimated GFR in the total population. Proteinuria was detected using standard dipstick.
During the 6-year observation period, there were 449 incident cases of glomerular hyperfiltration and 1653 cases of proteinuria. Current smokers had a 1.32-time higher risk for the development of glomerular hyperfiltration and a 1.51-time higher risk for proteinuria than nonsmokers after adjustment for baseline age, body mass index, systolic and diastolic BP, antihypertensive medication, diabetes, alcohol consumption, regular leisure-time physical activity, and estimated GFR. Both daily and cumulative cigarette consumption were associated with an increased risk for glomerular hyperfiltration and proteinuria in a dose-response manner.
In middle-aged Japanese men, smoking was associated with an increased risk of glomerular hyperfiltration and dipstick proteinuria. Of importance, past smokers did not exhibit any increased risk for these conditions.
肾小球高滤过和白蛋白尿伴发早期糖尿病肾病预示着未来的肾衰竭。横断面研究显示，吸烟与肾小球滤过率升高有关，而纵向研究则显示吸烟与肾脏恶化有关。与吸烟相关的肾小球高滤过和蛋白尿程度，推测是早期肾损伤的现象，迄今尚未得到满意的研究。
设计、地点、参与者和测量方法：本研究纳入了 10118 名年龄在 40 至 55 岁之间、无蛋白尿或肾功能不全的日本男性。采用日本改良肾脏病饮食方程估算肾小球滤过率。肾小球高滤过定义为估算肾小球滤过率≥117.0ml/min/1.73m²，即估算肾小球滤过率总人群中第 2.5 个百分位值以上。蛋白尿采用标准尿沉渣法检测。
在 6 年的观察期间，有 449 例发生肾小球高滤过，1653 例发生蛋白尿。校正基线年龄、体重指数、收缩压和舒张压、降压药物、糖尿病、饮酒、有规律的闲暇时间体力活动和估算肾小球滤过率后，与不吸烟者相比，当前吸烟者发生肾小球高滤过的风险增加 1.32 倍，发生蛋白尿的风险增加 1.51 倍。每天和累计吸烟量与肾小球高滤过和蛋白尿风险呈剂量反应关系。
在中年日本男性中，吸烟与肾小球高滤过和尿沉渣蛋白阳性相关。重要的是，曾经吸烟者并未表现出这些情况的风险增加。
