ABSTRACT Kidney disease divided into acute and chronic.

Chronic Kidney Disease grows progressively and slowly (mostly about years). In this case, kidney has lost its ability to mantain volume and composition of body fluids in a state of normal food intake. Chronic Kidney Disease happened because of many reasons that harm kidney nephron mass. ainly its form to be diffuse and bilateral parenchim kidney. !nless it"s stopped, finally all kidney nephron will be wrecked and replaced by scar. In recent years, it has become apparent that cigarette smoking is associated with e#cessive morbidity and mortality in various diseases. $ecently, however, the adverse effects of smoking on renal function have gained more attention, mainly through investigation in diabetic patients. %he purpose of this review is to summari&e recent findings from studies on relation of smoking and Chronic Kidney Disease. In these patients, smoking is related to such variables of renal dysfunction as albuminuria and hyperfiltration, which may accelerate the progression to loss of renal function. Keywords ' Chronic Kidney Disease, (moking, )asculopathy.

Background (moking has been identified to be the single greatest preventable cause of morbidity and mortality in the !nited (tates. In *+,- alone there were appro#imately .//,/// deaths in the !nited (tates that could be directly attributable to cigarette smoking. (mokers have a significantly higher risk in various disease than non smokers. (*) %here is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. Kidney Disease is the ninth leading cause of death in the !nited (tates. %he %hird 0ational 1ealth and 2#amination (urvey (01302( III) estimated that the prevalence of Chronic Kidney Disease in adults in the !nited (tates was **4 (*+,5 million) ' 6,64 (-,+ million) had stage *, 64 (-,6 million) had stage 5, .,64 (7,8 million) had stage 6, /,54 (.//.///) had stage ., and /,54 (6//.///) had stage -. (5) Data from the !($D( 5/// 3nnual $eport pro9ects that the Chronic Kidney Disease population in !nited (tates and its territories will continue to increase. Incident counts are pro9ected to rise to *75,887 by 5/*/.
(6)

%he

ultiple $isk :actor Intervention %rial ( $:I%) investigated 665,-.. men and

documented that smoking was significantly associated with an increased risk for Chronic *

Kidney Disease.(.) (moking induces albuminuria and accelerates progression to renal failure in persons with diabetes, but little is known about the relation between smoking and renal function in non diabetic persons.(-) 1uman has two kidney in their body. It"s a organ, bean shaped, maroon coloured, *5,- cm length and 5,- cm width, about *5-;*7- g weight in men and **-;*-- g weight in women. %he functions of kidney are e#cretion of organic waste ' urea, uric acid, creatinine, and product of catabolism hemoglobine and hormone< e#cretion of to#ic materials ' pollutant, food"s addition substance, drugs, or other chemical substance from human body< controlling ion concentrate ' natrium, kalium, calcium, magnesium, sulfate, and phosphate< controlling acid and base in human body ' controlling hydrogen ion, bicarbonate, and amonium, and product acid or base urine, depends on body needs< controlling blood production ' releases eritropoietin that controls red blood production in bone marrow< controlling blood pressure ' controlling fluids volume that essensial to control blood pressure and produces renin., important component of renin;angiotensin;aldosterone that increases blood pressure and urine retention< and controlling blood glucose and amino acid ' responsibility of nutrient concentrate in blood. 2ach kidney has one;four million nephron, unit of urine production. 2ach nephron has one vascular component and one tubule component. =lomerolus, capillary coil double; walled epithelial capsule surrounded, >owman capsule. =lomerolus and >owman capsule form kidney corpuscles. )isceral layer of >owman capsule, ephitelial internal layer. It"s cells modified to podosit, typical ephitelial cell in glomerular capsule. 2ach podosit sticks in outer layer of glomerular capillary through long primary processus that consists of secondary processus, pedicle. ?edicle is integrated with the same processus from podosit"s @neighbour". Integrated narrow space between pedicles, filtration slits, has 5- nm width. =lomerular filtration barrier, barrier tissue splits blood from glomerular capsule from space in >owman capsule. Consists of endothelium capillary, base membrane, and filtration slit. ?arietal layer >owman capsule forms the outer edge of kidney corpuscle. )ascular pole of kidney corpuscle, afferents arterioles entry glomerolus and efferent arterioles come out from glomerolus. !rinary pole of kidney corpuscle, glomerolus filtrates incoming flow to pro#imal convoluted tubule. ?ro#imal convoluted tubule, 3nsa 1enle, distal convoluted tubule, collecting tubule and collecting duct are included.(8)

%here are more than a hundred compounds in cigarette, for e#ample ammonia, arsen, butana, cadmium, carbon mono#yde, hydrogen sianida, metanol, naphtalene, phenol, polonium, toulena, uretan, vynil chloride, etc.(8) (moking is a strong risk factor for cardiovascular mortality in patients at risk for Chronic Kidney Disease. It also is strongly associated with the progression of nephropathy. %he results of one small study showed that smoking cessation reduced the progression of kidney disease by 6/ percent in patients with type * diabetes.(,) Current smokers had a higher median albumin e#cretion than non smokers and were more likely to have microalbuminuria and high normal albuminuria with elevated or decreased =:$. 3fter ad9ustment for several potential confounding factors, persons who smoked 5/ or fewer cigarettesAd and persons who smoked more than 5/ cigarettesAd, respectively, showed a dosedependent association between smoking and high normal albuminuria, microalbuminuria, elevated =:$, and decreased =:$, respectively. Buitting smoking was associated only with microalbuminuria. (+) (moking, a well known risk factor for many diseases, was recently proven to play an important role in renal diseases. (tudies showed that cigarette smoking is a risk factor for the development and progression of Chronic Kidney Disease (CKD) in community. In these studies, causes of CKD were heterogeneous, while other studies implied that the relationship between cigarette smoking and kidney impairment varied among underlying kidney diseases. 1owever, there is still uncertainty whether every kidney disease is eCually vulnerable due to cigarette smoking.(*/) Chronic Kidney Disease (CKD) is a worldwide public health problem. %he Kidney Disease Dutcomes Buality Initiative (KADDBI) of the 0ational Kidney :oundation (0K:) defines Chronic Kidney Disease as either kidney damage or a decreased glomerular filtration rate (=:$) of less than 8/ mEAminA*,76 m5 for 6 or more months. Fhatever the underlying etiology, the destruction of renal mass with irreversible sclerosis and loss of nephrons leads to a progressive decline in =:$. %he physical e#amination often is not very helpful. 1owever, it may reveal findings characteristic of the condition that is underlying or complications of Chronic Kidney Disease. :orty;five percent of patients with Chronic Kidney Disease have depressive symptoms at dialysis therapy initiation.(.)

In 5//5, KADDBI published its classification, as follows, (tage * ' Kidney damage with normal or increased =:$ (G +/ mEAminA*,76 m5)< (tage 5 ' ,+ mEAminA*,76 m5)< (tage 6 ' mEAminA*,76 m5 or dialysis). In stage * and stage 5, =:$ alone does not clinch the diagnosis. Dther markers of kidney damage, including abnormalities in the composition of blood or urine or imaging studies, should also be present in establishing a diagnosis of stage * and stage 5. ?atients with stages * ; 6 are generally asymptomatic< clinically manifestations typically appear in stages . ; -. 2arly diagnosis and treatment of the underlying cause andAor institution of secondary preventive measures is imperative in patients. %hese may delay, or possibly halt progression. Chronic Kidney Disease risk shows strong graded relationships to the si#th report of the Ioint 0ational Committee (I0C;)I) on prevention, detection evaluation and treatment of high blood pressure criteria for blood pressure, to diabetes, and to current cigarette smoking that are at least as strong in women as in men.(**) %here are two approaches to e#plain kidney breakdown, first from traditional theory said that all of nephron unit had been infected but different in all stage, and in spesific part of related nephron with some function could be all damage or change in structure. %he second theory, >ricker hypothesis, said that whether nephron is infected, so all of nephron would be damage, but the rest still could work normally. !remia will happen if total nephron is too many decreasing and kidney could not control ?1 and fluid imbalance. 2ven progressive, there is no changing in amount of salute that should be e#creted by kidney to mantain homeostatis. %he rest of health nephron become hypertrophy to work harder, carry the entire workload. %his occurs elevated =:$, soluteload, and tubulus reabsorption in each nephron even happen decreased =:$. It named an adaptation mechanism, and had successfully maintain ?1 and fluid balance until the lowest kidney functions. 3t last, about 7-4 nephron mass are damage, =:$ and soluteload for each nephron significantly high can occur glomerolus;tubulus imbalance (filtration and reabsorption). Eowering fle#ibility in e#cretion and even solute convertion process. ild reduction in =:$ (8/; oderate reduction in =:$ (6/;-+ mEAminA*,76 m5)< (tage .

' (evere reduction in =:$ (*-;5+ mEAminA*,76 m5)< and (tage - ' Kidney failure (=:$ H *-

?atient with +/4 mass nephron damage balance with health people with */ times soluteload. */4 rest forced to e#cret */ times than normal, and lost fle#ibility. 0ephron can not compensate the changes through reabsorption against overload or lost natrium or water. :unction adaptation of decreasing mass nephron causes systemic hypertension and increasing hyperfiltration of health nephron. 1yperfiltration is caused by afferent arteriol dilatation. 3t the same time, efferent arterion constriction because of angiotensin II released and increases kidney plasma flow and glomerular intracaplillary hydrostatic pressure.(*5) %he medical care of patients with Chronic Kidney Disease should focus on the following, delaying or halting the progression, treating the pathologic manifestations, and timely planning for long;term renal replacement therapy ($$%). ?atients with chronic kidney disease should be educated about the following, importance of compliance with secondary preventive measures< natural disease progression, prescribed medications (highlighting their potential benefits and adverse effects)< avoidance of nephroto#ins< diet, renal replacement modalities, including peritoneal dialysis, hemodialysis, and transplantation< and permanent vascular access options for hemodialysis. (5) 3nd for the smokers should be offered nicotine;replacement therapies (e.g., patch, gum) and the antidepressant bupropion (Jyban).(,)

The Correlation Between Smoking and Chronic Kidney Disease (tephan $. Drth and (tein I. 1allan, in their review tell that smoking is a risk factor of renal disease. %he dramatic worldwide increase of patients with Chronic Kidney Disease forces nephrologists to get done preventive strategies. Concerning the adverse effects of smoking on cardiovascular morbidity and mortality in patients with Chronic Kidney Disease, the studies discussed give sufficient evidence that smoking consult a similar cardiovascular risk as in the general population. %hey hope to have convinced the nephrologic community that motivation of patients to Cuit smoking should be immediately implemented, because it is certainly the most cost;effective and beneficial strategy against the whole spectrum of CKD, 2($D, and C)D morbidity and mortality in renal patients. %hey conclude that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.(.)

:rom 0etherland, (ara;Ioan ?into;(ietsma,

D and collegues found that current

smokers had a higher median albumin e#cretion than nonsmokers and were more likely to have microalbuminuria and high normal albuminuria with elevated or decreased =:$. 3fter ad9ustment for several potential confounding factors, persons who smoked 5/ or fewer cigarettesAd and persons who smoked more than 5/ cigarettesAd, respectively, showed a dosedependent association between smoking and high normal albuminuria and microalbuminuria, elevated =:$ and decreased =:$. Buitting smoking was associated only with microalbuminuria. (moking induces albuminuria and accelerates progression to renal failure in persons with diabetes, but little is known about the relation between smoking and renal function in nondiabetic persons. >ut in addition, they did not observe abnormal renal function or, to a lesser e#tent, albuminuria in participants who had stopped smoking.(+) (awicki, et al. performed a prospective follow;up study during * year in a seCuential sample. %hey reported that progression of diabetic nephropathy was observed in -64 of current smokers but only 664 of e#;smokers (and **4 of nonsmokers). (*7) %hese data were confirmed in patients with type 5 diabetes (progression in 554 of e#;smokers versus .54 in smokers Kand 564 in nonsmokersL).(*,) $abi Macoub found that smoking significantly increases the risk of CKD. Fhen compared to nonsmokers, current smokers have an increased risk of having CKD, while former smokers did not have a statistically significant difference. %he risk increased with high cumulative Cuantity. (moking increased the risk of CKD the most for those classified as hypertensive nephropathy and diabetic nephropathy. 0o statistically significant difference in risk was found for glomerulonephritis patients or any other causes. %hat study suggests that heavy cigarette smoking increases the risk of CKD overall and particularly for CKD classified as hypertensive nephropathy and diabetic nephropathy.(*/) Carla Cerami found that 3dvanced =lycation 2nd products (3=2s) are reactive, cross;linking moieties that form from the reaction of reducing sugars and the amino groups of proteins, lipids, and nucleic acids. 3=2s circulate in high concentrations in the plasma of patients with diabetes or renal insufficiency and have been linked to the accelerated vasculopathy seen in patients with these diseases. 3Cueous 2#tracts of %obacco and Cigarette (moke Contain =lycoto#ins, which promote 3=2 formation in vitro.(*)

Discussion (moking has relation with renal risk factor (., +, */, *7, *,) and it has strong relation with cardiovascular mortality in patients at risk for Chronic Kidney Disease. It is also strongly associated with the progression of nephropathy. (*8) %here is abundance different effects to renal between current smoker and former smoker. (ara;Ioan found that current smokers had a higher median albumin e#cretion than nonsmoker.(+) 1eavy smoking induces albuminuria and accelerates progression to renal failure in persons with hypertensive nephropathy and diabetic nephropathy(+,*/,
*7, *,)

, but little is known about the relation between smoking and

renal function in nondiabetic persons. 3nd (tephen $. Drth have convinced the nephrologic community that motivation of patients to Cuit smoking should be immediately implemented, because it is certainly the most cost;effective and beneficial strategy against the whole spectrum of CKD, 2($D, and C)D morbidity and mortality in renal patients. (.) 3=2s circulate in high concentrations in the plasma of patients with diabetes or renal insufficiency and have been linked to the accelerated vasculopathy seen in patients with these diseases. Cerami and colleagues showed that aCueous e#tracts of tobacco and cigarette smoke contain glycoto#ins, highly reactive glycation products that can rapidly induce in vitro and in vivo formation of 3=2 products on proteins.(*6) It is reasonable to e#pect that the advanced glycation end products formed by the reaction of glycoto#ins from cigarette smoke with serum and tissue proteins will affect the systemic and renal vasculature. %his review show here that both aCueous e#tracts of tobacco and cigarette smoke contain glycoto#ins, highly reactive glycation products that can rapidly induce 3=2 formation on proteins in vitro and in vivo.(*., *-)

Conclusion %here is strong relation between smoking and progression of Chronic Kidney Disease in hypertensive patient and diabetic patient. 3=2s contains glycoto#ins and play the role in that mechanism because it affects systemic and renal vasculature. %he progression of Chronic Kidney Disease in former smoker is not as bad as current smoker, and is not good as non smoker. (moking has not good thing at all. Fith Cuitting smoking, it will delay the progression of that process.