Table 4 Potential pathomechanisms of smoking-induced renal injury

• Increased sympathetic nerve activity

• Increase of blood pressure and heart rate

• Decreased fall of night-time blood pressure

• Increase of renal vascular resistance leading to a decrease in glomerular filtration rate and renal plasma flow

• Increase of intraglomerular capillary pressure

• Aggravation of hyperfiltration in patients with diabetic nephropathy

• Atherosclerosis of renal arteries and myointimal hyperplasia of the intrarenal arteries and arterioles

• Endothelin-1- and/or angiotensin II-mediated proliferation and matrix accumulation of vascular smooth muscle cells, endothelial cells and mesangial cells

• Tubulotoxic effects with alteration of tubular function

• Toxic effects on endothelial cells

• Oxidative stress

• Increased clotting of platelets

• Impaired lipoprotein and glycosaminoglycan metabolism

• Modulation of the immune response

• Vasopressin-mediated antidiuresis

• Insulin resistance